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Vereckei A. New Pacing Techniques and Non-Invasive Methods That May Improve Response to Cardiac Resynchronization Therapy. J Cardiovasc Dev Dis 2024; 11:208. [PMID: 39057628 PMCID: PMC11277212 DOI: 10.3390/jcdd11070208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Although cardiac resynchronization therapy (CRT) is an evidence-based effective therapy of symptomatic heart failure with reduced ejection fraction (HFrEF), refractory to optimal medical treatment and associated with intraventricular conduction disturbance, the non-response rate to CRT is still around 30% [...].
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Affiliation(s)
- András Vereckei
- Department of Medicine and Hematology, Semmelweis University, Szentkirályi u. 46, 1088 Budapest, Hungary
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2
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Noheria A, Shahab A, Andrews C, Cuculich PS, Rudy Y. Pilot study to evaluate left-to-right ventricular offset in biventricular pacing-comparison of electrocardiographic imaging and ECG. J Cardiovasc Electrophysiol 2024; 35:1185-1195. [PMID: 38591763 DOI: 10.1111/jce.16272] [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: 01/31/2024] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Biventricular pacing (BiVp) improves outcomes in systolic heart failure patients with electrical dyssynchrony. BiVp is delivered from epicardial left ventricular (LV) and endocardial right ventricular (RV) electrodes. Acute electrical activation changes with different LV-RV stimulation offsets can help guide individually optimized BiVp programming. We sought to study the BiVp ventricular activation with different LV-RV offsets and compare with 12-lead ECG. METHODS In five patients with BiVp (63 ± 17-year-old, 80% male, LV ejection fraction 27 ± 6%), we evaluated acute ventricular epicardial activation, varying LV-RV offsets in 20 ms increments from -40 to 80 ms, using electrocardiographic imaging (ECGI) to obtain absolute ventricular electrical uncoupling (VEUabs, absolute difference in average LV and average RV activation time) and total activation time (TAT). For each patient, we calculated the correlation between ECGI and corresponding ECG (3D-QRS-area and QRS duration) with different LV-RV offsets. RESULTS The LV-RV offset to attain minimum VEUabs in individual patients ranged 20-60 ms. In all patients, a larger LV-RV offset was required to achieve minimum VEUabs (36 ± 17 ms) or 3D-QRS-area (40 ± 14 ms) than that for minimum TAT (-4 ± 9 ms) or QRS duration (-8 ± 11 ms). In individual patients, 3D-QRS-area correlated with VEUabs (r 0.65 ± 0.24) and QRS duration correlated with TAT (r 0.95 ± 0.02). Minimum VEUabs and minimum 3D-QRS-area were obtained by LV-RV offset within 20 ms of each other in all five patients. CONCLUSIONS LV-RV electrical uncoupling, as assessed by ECGI, can be minimized by optimizing LV-RV stimulation offset. 3D-QRS-area is a surrogate to identify LV-RV offset that minimizes LV-RV uncoupling.
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Affiliation(s)
- Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ahmed Shahab
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher Andrews
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Phillip S Cuculich
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yoram Rudy
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
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Sisti N, Cardona A, Baldi E, Sciaccaluga C, Notaristefano F, Santoro A, Mandoli GE, Cameli M. Multimodality Imaging for Selecting Candidates for CRT: Do We Have a Single Alley to Increase Responders? Curr Probl Cardiol 2024; 49:102150. [PMID: 37863462 DOI: 10.1016/j.cpcardiol.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Cardiac resynchronization therapy has evolved in recent years to provide a reduction of morbidity and mortality for many patients with heart failure. Its application and optimization is an evolving field and its use requires a multidisciplinary approach for patient and device selection, technical preprocedural planning, and optimization. While echocardiography has always been considered the first line for the evaluation of patients, additional imaging techniques have gained increasing evidence in recent years. Today different details about heart anatomy, function, dissynchrony can be investigated by magnetic resonance, cardiac computed tomography, nuclear imaging, and more, with the aim of obtaining clues to reach a maximal response from the electrical therapy. The purpose of this review is to provide a practical analysis of the single and combined use of different imaging techniques in the preoperative and perioperative phases of cardiac resynchronization therapy, underlining their main advantages, limitations, and information provided.
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Affiliation(s)
- Nicolò Sisti
- Department of Cardiology, Hospital of Gubbio, Gubbio, Italy.
| | - Andrea Cardona
- Division of Advanced Cardiovascular Diagnostics, Regional Healthcare Unit, Todi Hospital, Todi, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | | | - Amato Santoro
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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Yan CL, Grazette L. A review of biomarker and imaging monitoring to predict heart failure recovery. Front Cardiovasc Med 2023; 10:1150336. [PMID: 37089891 PMCID: PMC10117884 DOI: 10.3389/fcvm.2023.1150336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023] Open
Abstract
Heart failure is a clinical syndrome caused by structural cardiac abnormalities that lead to increased intracardiac pressures and decreased cardiac output. Following cardiovascular insult or direct myocardial injury, neurohormonal activation triggers hemodynamic changes and cardiac remodeling to preserve cardiac output. While initially adaptive, cardiac remodeling eventually causes pathologic changes in cardiac structure that often compromise cardiac function. Reverse remodeling is the regression of abnormal cardiac chamber geometry and function after myocardial injury. In recent years, several classes of therapeutics have been associated with greater likelihood of reverse remodeling. Heart failure recovery and heart failure remission, terms encompassing the clinical correlates of reverse remodeling, have been associated with improved survival in patients with heart failure with reduced ejection. As such, identifying predictors of heart failure recovery can have important implications for guiding clinical practice and therapeutic innovation. This review addresses the role of biomarkers and imaging monitoring in predicting structural, functional, and clinical recovery in patients with acute and chronic heart failure.
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Affiliation(s)
- Crystal Lihong Yan
- Department of Medicine, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Luanda Grazette
- Division of Cardiovascular Medicine, University of Miami Health System, Miami, FL, United States
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Jones KA, Paterson CA, Ray S, Motherwell DW, Hamilton DJ, Small AD, Martin W, Goodfield NER. Beta-blockers and mechanical dyssynchrony in heart failure assessed by radionuclide ventriculography. J Nucl Cardiol 2023; 30:193-200. [PMID: 36417121 PMCID: PMC9984517 DOI: 10.1007/s12350-022-03142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Radionuclide ventriculography (RNVG) can be used to quantify mechanical dyssynchrony and may be a valuable adjunct in the assessment of heart failure with reduced ejection fraction (HFrEF). The study aims to investigate the effect of beta-blockers on mechanical dyssynchrony using novel RNVG phase parameters. METHODS A retrospective study was carried out in a group of 98 patients with HFrEF. LVEF and dyssynchrony were assessed pre and post beta-blockade. Dyssynchrony was assessed using synchrony, entropy, phase standard deviation, approximate entropy, and sample entropy from planar RNVG phase images. Subgroups split by ischemic etiology were also investigated. RESULTS An improvement in dyssynchrony and LVEF was measured six months post beta-blockade for both ischemic and non-ischemic groups. CONCLUSIONS A significant improvement in dyssynchrony and LVEF was measured post beta-blockade using novel measures of dyssynchrony.
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Affiliation(s)
- K A Jones
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK.
| | - C A Paterson
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - S Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow , UK
| | - D W Motherwell
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | - D J Hamilton
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - A D Small
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - W Martin
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - N E R Goodfield
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
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6
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Aimo A, Vergaro G, González A, Barison A, Lupón J, Delgado V, Richards AM, de Boer RA, Thum T, Arfsten H, Hülsmann M, Falcao-Pires I, Díez J, Foo RSY, Chan MYY, Anene-Nzelu CG, Abdelhamid M, Adamopoulos S, Anker SD, Belenkov Y, Ben Gal T, Cohen-Solal A, Böhm M, Chioncel O, Jankowska EA, Gustafsson F, Hill L, Jaarsma T, Januzzi JL, Jhund P, Lopatin Y, Lund LH, Metra M, Milicic D, Moura B, Mueller C, Mullens W, Núñez J, Piepoli MF, Rakisheva A, Ristić AD, Rossignol P, Savarese G, Tocchetti CG, van Linthout S, Volterrani M, Seferovic P, Rosano G, Coats AJS, Emdin M, Bayes-Genis A. Cardiac remodelling - Part 2: Clinical, imaging and laboratory findings. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2022; 24:944-958. [PMID: 35488811 DOI: 10.1002/ejhf.2522] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/06/2022] Open
Abstract
In patients with heart failure, the beneficial effects of drug and device therapies counteract to some extent ongoing cardiac damage. According to the net balance between these two factors, cardiac geometry and function may improve (reverse remodelling, RR) and even completely normalize (remission), or vice versa progressively deteriorate (adverse remodelling, AR). RR or remission predict a better prognosis, while AR has been associated with worsening clinical status and outcomes. The remodelling process ultimately involves all cardiac chambers, but has been traditionally evaluated in terms of left ventricular volumes and ejection fraction. This is the second part of a review paper by the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology dedicated to ventricular remodelling. This document examines the proposed criteria to diagnose RR and AR, their prevalence and prognostic value, and the variables predicting remodelling in patients managed according to current guidelines. Much attention will be devoted to RR in patients with heart failure with reduced ejection fraction because most studies on cardiac remodelling focused on this setting.
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Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Arantxa González
- CIMA Universidad de Navarra, and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Andrea Barison
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Josep Lupón
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
| | - Victoria Delgado
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Thomas Thum
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Henrike Arfsten
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Martin Hülsmann
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Javier Díez
- Center for Applied Medical Research, Pamplona, Spain
| | - Roger S Y Foo
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | - Mark Yan Yee Chan
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | - Chukwuemeka G Anene-Nzelu
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | | | - Stamatis Adamopoulos
- 2nd Department of Cardiovascular Medicine, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapy (BCRT), German Center for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Tuvia Ben Gal
- Cardiology Department, Rabin Medical Center, Beilinson, Israel
| | | | - Michael Böhm
- University of the Saarland, Homburg/Saar, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu' Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | - Ewa A Jankowska
- Institute of Heart Disases, Wroclaw Medical University, Wroclaw, Poland
| | - Finn Gustafsson
- Heart Centre, Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA
| | | | - Yuri Lopatin
- Volgograd State Medical University, Volgograd, Russia
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Metra
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davor Milicic
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | | | | | - Julio Núñez
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Massimo F Piepoli
- Cardiology Division, Castelsangiovanni Hospital, Castelsangiovanni, Italy
| | - Amina Rakisheva
- Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigations Cliniques-Plurithématique 1433 and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Carlo G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Sophie van Linthout
- Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | | | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe Rosano
- St. George's Hospitals, NHS Trust, University of London, London, UK
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Antoni Bayes-Genis
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update. J Am Coll Radiol 2022; 19:S37-S52. [PMID: 35550804 DOI: 10.1016/j.jacr.2022.02.014] [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: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/20/2022]
Abstract
Dyspnea is the symptom of perceived breathing discomfort and is commonly encountered in a variety of clinical settings. Cardiac etiologies of dyspnea are an important consideration; among these, valvular heart disease (Variant 1), arrhythmia (Variant 2), and pericardial disease (Variant 3) are reviewed in this document. Imaging plays an important role in the clinical assessment of these suspected abnormalities, with usually appropriate procedures including resting transthoracic echocardiography in all three variants, radiography for Variants 1 and 3, MRI heart function and morphology in Variants 2 and 3, and CT heart function and morphology with intravenous contrast for Variant 3. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Cleland JGF, Bristow MR, Freemantle N, Olshansky B, Gras D, Saxon L, Tavazzi L, Boehmer J, Ghio S, Feldman AM, Daubert JC, deMets D. The Effect of Cardiac Resynchronization without a Defibrillator on Morbidity and Mortality: An Individual-Patient-Data Meta-Analysis of COMPANION and CARE-HF. Eur J Heart Fail 2022; 24:1080-1090. [PMID: 35490339 PMCID: PMC9543287 DOI: 10.1002/ejhf.2524] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. OBJECTIVES To identify patient-characteristics that predict the effect, specifically, of CRT-pacemakers (CRT-P) on all-cause mortality or the composite of hospitalisation for heart failure or all-cause mortality. METHODS An individual patient-data meta-analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization - Heart Failure (CARE-HF) trials. Only patients assigned to CRT-P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. RESULTS Median age was 67 (59-73) years, most patients were men (70%), 68% had a QRS duration of 150-199 ms and 80% had left bundle branch block (LBBB). Patients assigned to CRT-P had lower rates for all-cause mortality (HR 0.68 (95% CI 0.56 to 0.81; p < 0.0001) and the composite outcome (HR 0.67 (95% CI 0.58 to 0.78; p < 0.0001). No pre-specified characteristic, including sex, aetiology of ventricular dysfunction, QRS duration (within the studied range) or morphology or PR interval significantly influenced the effect of CRT-P on all-cause mortality or the composite outcome. However, CRT-P had a greater effect on the composite outcome for patients with lower body surface area (BSA) and those prescribed beta-blockers. CONCLUSIONS CRT-P reduces morbidity and mortality in appropriately selected patients with heart failure. Benefits may be greater in smaller patients and in those receiving beta-blockers. Neither QRS duration nor morphology independently predicted the benefit of CRT-P.
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Affiliation(s)
- John G F Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow & National Heart & Lung Institute, Imperial College, London, UK
| | - Michael R Bristow
- University of Colorado Cardiovascular Institute, Aurora and Boulder, Colorado, USA
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, UK
| | - Brian Olshansky
- University of Iowa, Iowa City & Mercy Hospital - North Iowa, Mason City, Iowa, USA
| | | | - Leslie Saxon
- Keck School of Medicine, University of Southern California
| | - Luigi Tavazzi
- Maria Cecilia Hospital - GVM Care & Cotignola, Italy
| | - John Boehmer
- Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Stefano Ghio
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Arthur M Feldman
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | | | - David deMets
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Electrocardiographic and echocardiographic dyssynchrony parameters that might better predict the response to cardiac resynchronization therapy than QRS morphology and duration. J Geriatr Cardiol 2022; 19:98-100. [PMID: 35317395 PMCID: PMC8915425 DOI: 10.11909/j.issn.1671-5411.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Novel electrocardiographic dyssynchrony criteria that may improve patient selection for cardiac resynchronization therapy. J Geriatr Cardiol 2022; 19:31-43. [PMID: 35233221 PMCID: PMC8832041 DOI: 10.11909/j.issn.1671-5411.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an evidence-based effective therapy of symptomatic heart failure with reduced ejection fraction refractory to optimal medical treatment associated with intraventricular conduction disturbance, that results in electrical dyssynchrony and further deterioration of systolic ventricular function. However, the non-response rate to CRT is still 20%−40%, which can be decreased by better patient selection. The main determinant of CRT outcome is the presence or absence of significant ventricular dyssynchrony and the ability of the applied CRT technique to eliminate it. The current guidelines recommend the determination of QRS morphology and QRS duration and the measurement of left ventricular ejection fraction for patient selection for CRT. However, QRS morphology and QRS duration are not perfect indicators of electrical dyssynchrony, which is the cause of the not negligible non-response rate to CRT and the missed CRT implantation in a significant number of patients who have the appropriate substrate for CRT. Using imaging modalities, many ventricular dyssynchrony criteria were devised for the detection of mechanical dyssynchrony, but their utility in patient selection for CRT is not yet proven, therefore their use is not recommended for this purpose. Moreover, CRT can eliminate only mechanical dyssynchrony due to underlying electrical dyssynchrony, for this reason ECG has a greater role in the detection of ventricular dyssynchrony than imaging modalities. To improve assessment of electrical dyssynchrony, we devised two novel ECG dyssynchrony criteria, which can estimate interventricular and left ventricular intraventricular dyssynchrony in order to improve patient selection for CRT. Here we discuss the results achieved by the application of these new ECG dyssynchrony criteria, which proved to be useful in predicting the CRT response in patients with nonspecific intraventricular conduction disturbance pattern (the second greatest group of CRT candidates), and the significance of other new ECG dyssynchrony criteria in the potential improvement of CRT outcome.
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Ogano M, Tsuboi I, Tanabe J. Cardiac resynchronization therapy for electrical dyssynchrony with a narrow QRS duration and left anterior hemiblock. HeartRhythm Case Rep 2021; 7:829-832. [PMID: 34987969 PMCID: PMC8695277 DOI: 10.1016/j.hrcr.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Michio Ogano
- Address reprint requests and correspondence: Dr Michio Ogano, Division of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan.
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Quantitative mechanical dyssynchrony in dilated cardiomyopathy measured by deformable registration algorithm. Eur Radiol 2020; 30:2010-2020. [PMID: 31953665 DOI: 10.1007/s00330-019-06578-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the diagnostic value and reproducibility of deformable registration algorithm (DRA)-derived mechanical dyssynchrony parameters in dilated cardiomyopathy (DCM) patients. METHODS The present study included 80 DCM patients (40 with normal QRS duration (NQRS-DCM); 40 with left bundle branch block (LBBB-DCM)) and 20 healthy volunteers. The balanced steady-state free-precession (bSSFP) cine images were acquired using a 3.0T scanner. Mechanical dyssynchrony parameters were calculated based on DRA-derived segmental strain, including uniformity ratio estimate (URE) and standard derivation of time-to-peak (T2Psd) parameters in circumferential, radial, and longitudinal orientations. RESULTS DCM patients showed significant mechanical dyssynchrony reflected by both URE and T2Psd parameters compared with controls. Among DCM patients, LBBB-DCM showed decreased CURE (0.78 ± 0.21 vs. 0.93 ± 0.05, p < 0.001) and RURE (0.69 ± 0.14 vs. 0.83 ± 0.15, p = 0.001), and increased T2Psd-Ecc (median with interquartile range, 94.1 (54.4-123.2) ms vs. 63.7 (44.9-80.4) ms, p = 0.003) and T2Psd-Err (91.1 (61.1-103.2) ms vs. 62.3 (46.3-104.5) ms, p = 0.041) compared with NQRS-DCM patients. CURE showed a strong correlation with QRS duration (r = - 0.54, p < 0.001), with maximum AUC (0.791) to differentiate LBBB-DCM from NQRS-DCM patients. Improved intra- and inter-observer reproducibility was found using URE indices (coefficient of variation (CoV), 1.20-3.17%) than T2Psd parameters (CoV, 15.28-41.18%). CONCLUSIONS The DRA-based CURE showed significant correlation with QRS duration and the highest discriminatory value between LBBB-DCM and NQRS-DCM patients. URE indices showed greater reproducibility compared with T2Psd parameters for assessing myocardial dyssynchrony in DCM patients. KEY POINTS • The strain analyses based on DRA suggested that DCM patients have varying degrees of mechanical dyssynchrony and there is a significant difference from normal controls. • CURE showed the strongest correlation with QRS duration and was the best parameter for differentiating DCM patients with normal QRS duration from patients with LBBB, and with normal controls. • URE indices showed improved reproducibility compared with T2Psd parameters in all three orientations (circumferential, radial, and longitudinal).
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Koshy SKG, George MK, George LK. Value of early detection of left ventricular mechanical dyssynchrony for assessing long‐term outcomes. Echocardiography 2019; 36:1970-1971. [DOI: 10.1111/echo.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Santhosh K. G. Koshy
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas
| | - Mathew K. George
- Department of Anatomy and Neurobiology University of Tennessee Health Sciences Center Memphis Tennessee
| | - Lekha K. George
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas
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Al Saikhan L, Park C, Hughes AD. Reproducibility of Left Ventricular Dyssynchrony Indices by Three-Dimensional Speckle-Tracking Echocardiography: The Impact of Sub-optimal Image Quality. Front Cardiovasc Med 2019; 6:149. [PMID: 31649937 PMCID: PMC6795682 DOI: 10.3389/fcvm.2019.00149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: 3D speckle-tracking echocardiography (3D-STE) is a novel method to quantify left ventricular (LV) mechanical dyssynchrony. 3D-STE is influenced by image quality, but studies on the magnitude of its effect on 3D-STE derived LV systolic dyssynchrony indices (SDIs) and their test-retest reproducibility are limited. Methods: 3D-STE was performed in two groups, each comprising 18 healthy volunteers with good echocardiographic windows. In study 1, optimal and inferior-quality images, by intentionally poor echocardiographic technique, were acquired. In study 2, sub-optimal quality images were acquired by impairing ultrasound propagation using neoprene rubber sheets (thickness 2, 3, and 4 mm) mimicking mildly, moderately, and severely impaired images, respectively. Measures (normalized to cardiac cycle duration) were volume- and strain-based SDIs defined as the standard deviation of time to minimum segmental values, and volume- and strain-derived dispersion indices. For both studies test-retest reproducibility was assessed. Results: Test-retest reproducibility was better for most indices when restricting the analysis to good quality images; nevertheless, only volume-, circumferential strain-, and principal tangential strain-derived LV dyssynchrony indices achieved fair to good reliability. There was no evidence of systematic bias due to sub-optimal quality image. Volume-, circumferential strain-, and principal tangential strain-derived SDIs correlated closely. Radial strain- and longitudinal strain-SDI correlated moderately or weakly with volume-SDI, respectively. Conclusions: Sub-optimal image quality compromised the reliability of 3D-STE derived dyssynchrony indices but did not introduce systematic bias in healthy individuals. Even with optimal quality images, only 3D-STE indices based on volume, circumferential strain and principal tangential strain showed acceptable test-retest reliability.
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Affiliation(s)
- Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, London, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, London, United Kingdom
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Imaging, Biomarker, and Clinical Predictors of Cardiac Remodeling in Heart Failure With Reduced Ejection Fraction. JACC-HEART FAILURE 2019; 7:782-794. [PMID: 31401101 DOI: 10.1016/j.jchf.2019.06.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 12/25/2022]
Abstract
In response to injury, hemodynamic changes, or neurohormonal activation, the heart undergoes a series of structural and functional changes that have been termed cardiac remodeling. Remodeling is defined as changes in cardiac geometry and/or function over time and can be measured in terms of changes in cardiac chamber dimensions, wall thickness, volumes, mass, and ejection fraction at serial imaging examinations. As to cardiac chambers, left ventricular (LV) remodeling has been best studied in patients with heart failure with reduced ejection fraction. Although LV remodeling may compensate for abnormal hemodynamic parameters and function in the short term, left unchecked, it is associated with worsening cardiac function and poor prognosis. On the other hand, reversing LV geometry and/or function closer to that of a normal heart (also known as reverse remodeling) is associated with improved cardiac function and better prognosis. Because of its close relationship with clinical outcomes, remodeling may potentially be targeted in clinical management and used in trials as a surrogate endpoint. Standardized definition of remodeling and reliable tools to predict and monitor the presence, direction, and magnitude of cardiac remodeling are needed. Together with clinical and imaging findings, circulating biomarkers (most notably N-terminal pro-B-type natriuretic peptide, high-sensitivity troponin, and soluble suppression of tumorigenesis-2) may be helpful in this respect.
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The Prognostic Value of Diastolic and Systolic Mechanical Left Ventricular Dyssynchrony Among Patients With Coronary Heart Disease. JACC Cardiovasc Imaging 2019; 12:1215-1226. [DOI: 10.1016/j.jcmg.2018.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 11/22/2022]
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Gimelli A, Liga R, Menichetti F, Soldati E, Bongiorni MG, Marzullo P. Interactions between myocardial sympathetic denervation and left ventricular mechanical dyssynchrony: A CZT analysis. J Nucl Cardiol 2019; 26:509-518. [PMID: 28808889 DOI: 10.1007/s12350-017-1036-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND A correlation between left ventricular (LV) dyssynchrony (LVD) and impaired myocardial sympathetic tone has been hypothesized. We sought to assess the interactions between regional LV sympathetic innervation, perfusion, and mechanical dyssynchrony. METHODS Eighty-three patients underwent evaluation of LV perfusion and sympathetic innervation on 99mTc-tetrofosmin/123I-metaiodobenzylguanidine (123I-MIBG) imaging. The summed rest score and summed 123I-MIBG score (SS-MIBG) were computed. The extent of "innervation/perfusion" mismatch was defined as the number of denervated LV segments with relatively preserved perfusion. LVD was evaluated on phase analysis and the wall with latest mechanical activation identified. RESULTS LVD was revealed in 36 (43%) patients. Patients with LVD had more abnormal values of SRS (21 ± 9 vs 10 ± 8, P < 0.001) and SS-MIBG (29 ± 9 vs 17 ± 11, P < 0.001) than those without LVD. The presence of LVD also clustered with a higher burden of "innervation/perfusion" mismatch (P = 0.019). On per-wall analysis, LV walls with delayed mechanical activation showed a higher burden of "innervation/perfusion" mismatch (2.3 ± 1.4 segments) than normally contracting walls (1.3 ± 1.2 segments; P < 0.001). On multivariate analysis, the extent of "innervation/perfusion" mismatch was the only predictor of delayed mechanical activation (P = 0.029). CONCLUSIONS Patients with LVD show an elevated burden of "innervation/perfusion" mismatch that is concentrated at the level of the most dyssynchronous walls.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy.
| | | | - Francesca Menichetti
- Cardio-Thoracic and Vascular department, University Hospital of Pisa, Pisa, Italy
| | - Ezio Soldati
- Cardio-Thoracic and Vascular department, University Hospital of Pisa, Pisa, Italy
| | | | - Paolo Marzullo
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Abstract
Cardiac resynchronization therapy (CRT) is an electrical therapy to resolve an electrical problem. Any method to predict CRT response must specifically reflect the electrical substrate. Time-to-peak dyssynchrony is too unspecific for prediction of response because dyssynchrony by this approach may reflect the presence of scar or fibrosis even in the absence of conduction delay. New methods are based on the actual physiology of activation delay-induced heart failure (HF) and are superior to time-to-peak methods in predicting CRT response. Time-to-peak dyssynchrony may be used for prognosis in HF patients without signs of delayed ventricular activation and for monitoring CRT response.
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Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark.
| | - Niels Risum
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
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Impact of Left Bundle Branch Block on Left Atrial Dyssynchrony and Its Relationship to Left Ventricular Diastolic Function in Patients with Heart Failure and Dilated Cardiomyopathy. INTERNATIONAL JOURNAL OF HEART FAILURE 2019; 1:42-52. [PMID: 36262744 PMCID: PMC9536671 DOI: 10.36628/ijhf.2019.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 11/18/2022]
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20
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Modin D, Biering-Sørensen SR, Møgelvang R, Jensen JS, Biering-Sørensen T. Prognostic Importance of Left Ventricular Mechanical Dyssynchrony in Predicting Cardiovascular Death in the General Population. Circ Cardiovasc Imaging 2018; 11:e007528. [DOI: 10.1161/circimaging.117.007528] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Daniel Modin
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
| | - Sofie Reumert Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
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Vancheri F, Henein M. The impact of age on cardiac electromechanical function in asymptomatic individuals. Echocardiography 2018; 35:1788-1794. [PMID: 30239038 DOI: 10.1111/echo.14145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/31/2018] [Accepted: 08/26/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIM Whether aging affects left ventricular (LV) filling and ejection and the LV electric function is not well established. We investigated the effect of normal aging on echocardiographic measurements of LV morphology and function, LV electric function and the relationship between LV electric and mechanical function in asymptomatic individuals. METHODS As part of a cross-sectional survey for the prevalence of coronary risk factors in the general population in Caltanissetta, Italy, individuals without signs or symptoms of coronary artery disease or heart failure were randomly selected and underwent electrocardiographic and echocardiographic examination. QRS duration and amplitude, PR, QT and QTc intervals, were automatically measured. Echocardiographic examination included the measurement of LV systolic and diastolic dimensions, volumes and ejection fraction (EF). From the spectral Doppler flow LV early diastolic (E wave) and atrial systolic (A wave) velocities, isovolumic relaxation time (IVRT) and isovolumic contraction time (IVCT) were measured. Global LV dyssynchrony was assessed using the total isovolumic time (T-IVT) and the Tei index. RESULTS Aging reduced LV long-axis function, LV filling time and E wave velocity and prolonged T-IVT, IVRT and Tei index. It did not affect LV dimensions, ejection fraction, IVCT or QRS amplitude and duration. QRS duration correlated with LV dimensions, wall thickness and left atrial area. QRS amplitude and QTc interval correlated with the markers of LV dyssynchrony T-IVT and Tei index. CONCLUSIONS Overall, systolic and electric LV function are not affected by age, whereas subendocardial function, diastolic and synchronous function are significantly influenced.
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Affiliation(s)
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Molecular & Clinical Sciences Research Institute, St George University, London, UK.,Brunel University, London, UK
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Noringriis I, Modin D, Pedersen SH, Jensen JS, Biering-Sørensen T. Prognostic importance of mechanical dyssynchrony in predicting heart failure development after ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2018; 35:87-97. [PMID: 30143920 DOI: 10.1007/s10554-018-1443-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
Abstract
The aim of this study is to assess the prognostic value of mechanical dyssynchrony defined as the standard deviation of the time to peak longitudinal strain (SD T2P LS) in predicting the development of heart failure (HF) after an ST-segment elevation myocardial infarction (STEMI). Three hundred and seventy-three patients were admitted with STEMI and treated with primary percutaneous coronary intervention. Left ventricular (LV) mechanical dyssynchrony was examined through speckle tracking echocardiography and defined as SD T2P LS. The association with the outcome of HF hospitalization was assessed using Cox proportional hazard models. During a median follow-up of 5.12 years, 144 patients (38.6%) were admitted due to HF. Worse dyssynchrony was associated with the outcome in unadjusted and multivariable analysis (multivariable hazard ratio 1.05, 95% confidence interval 1.00-1.10, p-value 0.039, per 10 ms increase), but not after further adjustment for LV ejection fraction (LVEF), E/e' and global longitudinal strain (GLS) (hazard ratio 1.01, 95% confidence interval 1.00-1.07, p-value 0.71, per 10 ms increase), nor in a model only adjusting for GLS (hazard ratio 1.01, 95% confidence interval 1.00-1.06, p-value 0.61, per 10 ms increase). These findings were reproduced in a competing risk analysis treating all-cause mortality as a competing risk. LV mechanical dyssynchrony, as assessed by SD T2P LS is not an independent predictor of post-STEMI HF development and mechanical dyssynchrony does not provide independent prognostic information regarding HF when GLS is known.
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Affiliation(s)
- Inge Noringriis
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
| | - Daniel Modin
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
| | - Sune H Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
| | - Jan S Jensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
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Bax JJ, Delgado V, Sogaard P, Singh JP, Abraham WT, Borer JS, Dickstein K, Gras D, Brugada J, Robertson M, Ford I, Krum H, Holzmeister J, Ruschitzka F, Gorcsan J. Prognostic implications of left ventricular global longitudinal strain in heart failure patients with narrow QRS complex treated with cardiac resynchronization therapy: a subanalysis of the randomized EchoCRT trial. Eur Heart J 2018; 38:720-726. [PMID: 28426885 DOI: 10.1093/eurheartj/ehw506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/29/2016] [Indexed: 11/13/2022] Open
Abstract
Aim Left ventricular (LV) global longitudinal strain (GLS) reflects LV systolic function and correlates inversely with the extent of LV myocardial scar and fibrosis. The present subanalysis of the Echocardiography Guided CRT trial investigated the prognostic value of LV GLS in patients with narrow QRS complex. Methods and results Left ventricular (LV) global longitudinal strain (GLS) was measured on the apical 2-, 4- and 3-chamber views using speckle tracking analysis. Measurement of baseline LV GLS was feasible in 755 patients (374 with cardiac resynchronization therapy (CRT)-ON and 381 with CRT-OFF). The median value of LV GLS in the overall population was 7.9%, interquartile range 6.2-10.1%. After a mean follow-up period of 19.4 months, 95 patients in the CRT-OFF group and 111 in the CRT-ON group reached the combined primary endpoint of all-cause mortality and heart failure hospitalization. Each 1% absolute unit decrease in LV GLS was independently associated with 11% increase in the risk to reach the primary endpoint (Hazard ratio 1.11; 95% confidence interval 95% 1.04-1.17, P < 0.001), after adjusting for ischaemic cardiomyopathy and randomization treatment among other clinically relevant variables. When categorizing patients according to quartiles of LV GLS, the primary endpoint occurred more frequently in patients in the lowest quartile (<6.2%) treated with CRT-ON vs. CRT-OFF (45.6% vs. 28.7%, P = 0.009) whereas, no differences were observed in patients with LV GLS ≥6.2% treated with CRT-OFF vs. CRT-ON (23.7% vs. 24.5%, respectively; P = 0.62). Conclusion Low LV GLS is associated with poor outcome in heart failure patients with QRS width <130 ms, independent of randomization to CRT or not. Importantly, in the group of patients with the lowest LV GLS quartile, CRT may have a detrimental effect on clinical outcomes.
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Affiliation(s)
- Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Peter Sogaard
- Aalborg University, Fredrik Bajers Vej 7-D3, Aalborg 9220, Denmark
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Corrigan Minehan Heart Center, 55 Fruit Street, Boston, MA 02114, USA
| | - William T Abraham
- The Division of Cardiovascular Medicine, Ohio State University Medical Center, Davis Heart and Lung Research Institute, 473 West 12th Avenue, Room 110P, Columbus, OH 43210-1252, USA
| | - Jeffrey S Borer
- The Division of Cardiovascular Medicine and Howard Gilman and Ron and Jean Schiavone Institutes, State University of New York Downstate College of Medicine, 450 Clarkson Avenue, Division of Cardiovascular Medicine, Sixth Floor, Brooklyn, NY, New York, USA
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Postboks 8600 Forus, 4036 Stavanger, Norway
| | - Daniel Gras
- Nouvelles Cliniques Nantaises, 2 - 4 Rue Eric Tabarly, 44200 Nantes, France
| | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Michele Robertson
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Victoria 3800, Australia
| | - Johannes Holzmeister
- Clinic for Cardiology, University Hospital Zurich, Moussonstrasse 4, CH 8091 Zürich, Switzerland
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Moussonstrasse 4, CH 8091 Zürich, Switzerland
| | - John Gorcsan
- The University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
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Tayal B, Gorcsan J, Bax JJ, Risum N, Olsen NT, Singh JP, Abraham WT, Borer JS, Dickstein K, Gras D, Krum H, Brugada J, Robertson M, Ford I, Holzmeister J, Ruschitzka F, Sogaard P. Cardiac Resynchronization Therapy in Patients With Heart Failure and Narrow QRS Complexes. J Am Coll Cardiol 2018; 71:1325-1333. [DOI: 10.1016/j.jacc.2018.01.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
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Liu S, Guan Z, Jin X, Meng P, Wang Y, Zheng X, Jia D, Ma C, Yang J. Left ventricular diastolic and systolic dyssynchrony and dysfunction in heart failure with preserved ejection fraction and a narrow QRS complex. Int J Med Sci 2018; 15:108-114. [PMID: 29333094 PMCID: PMC5765723 DOI: 10.7150/ijms.21956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/12/2017] [Indexed: 12/17/2022] Open
Abstract
Aims: Mechanical dyssynchrony has been reported in heart failure with preserved ejection fraction (HFpEF), with a majority of patients having a narrow QRS complex; however, whether any benefit is observed with restoration of dyssynchrony remains unclear. We sought to assess left ventricular (LV) dyssynchrony and function in HFpEF and elucidate the underlying mechanisms that may account for HFpEF. Methods: Seventy-eighty patients with a narrow QRS complex including 47 with HFpEF, 31 with heart failure with reduced ejection fraction (HFrEF) patients, and 29 with asymptomatic left ventricular diastolic dysfunction (LVDD) were recruited. Forty-five normal subjects acted as controls. Systolic LV longitudinal strain (LS), systolic longitudinal strain rate (LSrS), early diastolic longitudinal strain rate (LSrE), and late diastolic longitudinal strain rate (LSrA) were measured using speckle tracking echocardiography. LV diastolic and systolic dyssynchrony (Te-SD and Ts-SD) were calculated. Results: Te-SD and Ts-SD were prolonged in HFpEF and HFrEF patients than in the control group (p<0.05). However, Ts-SD was shorter in HFpEF patients compared to HFrEF patients despite a narrow QRS complex (p<0.05). LV global LS, LSrS, and LSrE were decreased in patients with HFpEF and HFrEF compared to other groups, with HFrEF being even more reduced than HFpEF (p<0.05). Reduced LS, LSrS, and LSrE could effectively differentiate HF from asymptomatic LVDD patients (p<0.05). Conclusion: HFrEF exhibited increased systolic dyssynchrony compared to HFpEF despite a narrow QRS complex in addition to the more reduced diastolic and systolic function. Therefore, targeting to improve diastolic and systolic function instead of managing systolic dyssynchrony might be of great importance in the treatment of HFpEF.
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Affiliation(s)
- Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Zhengyu Guan
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Xuanyi Jin
- Department of Cardiology, Mayo Clinic (Arizona), Scottsdale, Arizona, United States, 85259
| | - Pingping Meng
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Xianfeng Zheng
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Dalin Jia
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
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Gorcsan J, Lumens J. Rocking and Flashing With RV Pacing. JACC Cardiovasc Imaging 2017; 10:1100-1102. [DOI: 10.1016/j.jcmg.2016.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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Stankovic I, Belmans A, Prinz C, Ciarka A, Maria Daraban A, Kotrc M, Aarones M, Szulik M, Winter S, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. The association of volumetric response and long-term survival after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2017; 18:1109-1117. [DOI: 10.1093/ehjci/jex188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/26/2017] [Indexed: 01/22/2023] Open
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28
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Biering-Sørensen T, Shah SJ, Anand I, Sweitzer N, Claggett B, Liu L, Pitt B, Pfeffer MA, Solomon SD, Shah AM. Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction. Eur J Heart Fail 2017; 19:1043-1052. [PMID: 28322009 DOI: 10.1002/ejhf.789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 12/24/2022] Open
Abstract
AIMS Left ventricular mechanical dyssynchrony has been described in heart failure with preserved ejection fraction (HFpEF), but its prognostic significance is not known. METHODS AND RESULTS Of 3445 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, dyssynchrony analysis was performed on 424 patients (12%) by multiple speckle tracking echocardiography strain-based criteria. The primary dyssynchrony analysis was the standard deviation of the time to peak longitudinal strain (SD T2P LS). Cox proportional hazards models assessed the association of dyssynchrony with the composite outcome of cardiovascular death or heart failure hospitalization. Mean age was 70 ± 10 years, LVEF was 60 ± 8%, and QRS duration was 101 ± 27 ms. Worse dyssynchrony, reflected in SD T2P LS, was associated with wider QRS, prior myocardial infarction, larger LV volume and mass, and worse systolic (lower LVEF and global longitudinal strain) and diastolic (lower e' and higher E/e') function. During a median follow-up of 2.6 (interquartile range 1.5-3.8) years, 107 patients experienced the composite outcome. Worse dyssynchrony was associated with the composite outcome in unadjusted analysis [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.07; P = 0.021, per 10 ms increase], but not after adjusting for clinical characteristics, or after further adjustment for LVEF, AF, NYHA class, stroke, heart rate, creatinine, haematocrit, and QRS duration (HR 1.03, 95% CI 0.99-1.06; P = 0.16, per 10 ms increase). CONCLUSION Worse LV mechanical dyssynchrony, assessed by speckle tracking echocardiography, is not an independent predictor of adverse outcomes in HFpEF, suggesting that mechanical dyssynchrony is unlikely to be an important mechanism underlying this syndrome. These findings warrant validation in an independent study specifically designed to assess the prognostic utility of mechanical dyssynchrony in HFpEF. TRIAL REGISTRATION NCT00094302.
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Affiliation(s)
- Tor Biering-Sørensen
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Sanjiv J Shah
- Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Inder Anand
- Cardiovascular Division, VA Medical Center, Minneapolis, MN, USA
| | - Nancy Sweitzer
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Li Liu
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Bertram Pitt
- Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Tayal B, Sogaard P, Delgado-Montero A, Goda A, Saba S, Risum N, Gorcsan J. Interaction of Left Ventricular Remodeling and Regional Dyssynchrony on Long-Term Prognosis after Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2017; 30:244-250. [DOI: 10.1016/j.echo.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 10/20/2022]
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30
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Kosiuk J, Koutalas E, Breithardt OA. Too weak to withstand the strain: another piece in the CRT puzzle. Eur Heart J 2017; 38:727-729. [DOI: 10.1093/eurheartj/ehw575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Galli E, Leclercq C, Donal E. Mechanical dyssynchrony in heart failure: Still a valid concept for optimizing treatment? Arch Cardiovasc Dis 2017; 110:60-68. [DOI: 10.1016/j.acvd.2016.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/15/2022]
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32
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Nägele MP, Steffel J, Robertson M, Singh JP, Flammer AJ, Bax JJ, Borer JS, Dickstein K, Ford I, Gorcsan J, Gras D, Krum H, Sogaard P, Holzmeister J, Abraham WT, Brugada J, Ruschitzka F. Effect of cardiac resynchronization therapy in patients with diabetes randomized in
EchoCRT. Eur J Heart Fail 2016; 19:80-87. [DOI: 10.1002/ejhf.655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/20/2016] [Accepted: 08/03/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Matthias P. Nägele
- Department of Cardiology University Heart Centre Zurich Zurich Switzerland
| | - Jan Steffel
- Department of Cardiology University Heart Centre Zurich Zurich Switzerland
| | - Michele Robertson
- Robertson Centre for Biostatistics University of Glasgow Glasgow United Kingdom
| | - Jagmeet P. Singh
- Cardiac Arrhythmia Service Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Andreas J. Flammer
- Department of Cardiology University Heart Centre Zurich Zurich Switzerland
| | - Jeroen J. Bax
- Department of Cardiology Leiden University Medical Centre Leiden the Netherlands
| | - Jeffrey S. Borer
- Division of Cardiovascular Medicine and Howard Gilman and Ron and Jean Schiavone Institutes State University of New York Downstate College of Medicine New York NY USA
| | - Kenneth Dickstein
- University of Bergen Bergen Norway
- Stavanger University Hospital Stavanger Norway
| | - Ian Ford
- Robertson Centre for Biostatistics University of Glasgow Glasgow United Kingdom
| | | | | | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics Melbourne VIC Australia
| | - Peter Sogaard
- Department of Cardiology and Clinical Institute Aalborg University Hospital Aalborg Denmark
| | | | - William T. Abraham
- Division of Cardiovascular Medicine Ohio State University Medical Center Columbus OH USA
| | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clinic University of Barcelona Spain
| | - Frank Ruschitzka
- Department of Cardiology University Heart Centre Zurich Zurich Switzerland
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What is the cost of non-response to cardiac resynchronization therapy? Hospitalizations and healthcare utilization in the CRT-D population. J Interv Card Electrophysiol 2016; 47:189-195. [PMID: 27613184 DOI: 10.1007/s10840-016-0180-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/18/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF) with left ventricular systolic dysfunction and prolonged QRS interval. However, one third of patients do not benefit from treatment. This study compares the heart failure hospitalization (HFH) rates and corresponding costs between responders and non-responders to CRT. METHODS At a single center in New Jersey, we enrolled patients with de novo CRT-D implants between January 2011 and July 2013. Medical history at implant and all subsequent hospitalizations were collected. A retrospective chart review of the cardiology visit at or closest to 12 months post-CRT implant was performed, and patients were classified into responders and non-responders. Universal billing records (UB-04), ICD-9-CM diagnoses, and procedure codes were used to determine whether each hospitalization was due to HF. For each heart failure hospitalization (HFH), an MS-DRG-based US national average Medicare reimbursement was determined. HFH rates and associated payor costs were compared between responders and non-responders using negative binomial regression and non-parametric bootstrapping (×10,000), respectively. RESULTS CRT response was determined in 135 patients (n = 103 responders, n = 32 non-responders, average follow-up 1.4 years). Demographics, pre-implant HF characteristics, NYHA Class, QRS duration, ejection fraction (EF), left bundle branch block (LBBB) status, and co-morbidities were not statistically different between the two groups. The HFH rate was significantly lower in responders (0.43/patient year) compared to non-responders (0.96/patient year, IRR = 0.45, 95 % CI (0.23 0.90), P = 0.0197). Average US national Medicare reimbursement for the responder group (US$7205/patient year) was 48 % lower than that for the non-responder group (US$13,861/patient year, P = 0.035). CONCLUSION In this single-center retrospective study, responders to CRT had significantly lower rates of post-implant heart failure hospitalization rate and reduced associated payor costs compared to non-responders. Therapies that increase CRT response rates can substantially reduce healthcare utilization.
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Marechaux S, Menet A, Guyomar Y, Ennezat PV, Guerbaai RA, Graux P, Tribouilloy C. Role of echocardiography before cardiac resynchronization therapy: new advances and current developments. Echocardiography 2016; 33:1745-1752. [DOI: 10.1111/echo.13334] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sylvestre Marechaux
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
- INSERM U 1088; University of Picardie; Amiens France
| | - Aymeric Menet
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
- INSERM U 1088; University of Picardie; Amiens France
| | - Yves Guyomar
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
| | | | - Raphaëlle Ashley Guerbaai
- Cardiology Department; Grenoble University Hospital; Grenoble France
- Cardiovascular and Thoracic Department; Amiens University Hospital; Amiens France
| | - Pierre Graux
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
| | - Christophe Tribouilloy
- INSERM U 1088; University of Picardie; Amiens France
- Cardiovascular and Thoracic Department; Amiens University Hospital; Amiens France
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Delgado-Montero A, Tayal B, Goda A, Ryo K, Marek JJ, Sugahara M, Qi Z, Althouse AD, Saba S, Schwartzman D, Gorcsan J. Additive Prognostic Value of Echocardiographic Global Longitudinal and Global Circumferential Strain to Electrocardiographic Criteria in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004241. [DOI: 10.1161/circimaging.115.004241] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/28/2016] [Indexed: 11/16/2022]
Abstract
Background—
Response to cardiac resynchronization therapy is most favorable in patients with heart failure with QRS duration ≥150 ms and left bundle branch block and less predictable in those with QRS width 120 to 149 ms or non–left bundle branch block.
Methods and Results—
We studied 205 patients with heart failure referred for cardiac resynchronization therapy with QRS ≥120 ms and ejection fraction ≤35%. We tested the hypothesis that contractile function using speckle-tracking echocardiographic global circumferential strain (GCS) from 2 short-axis views and global longitudinal strain (GLS) from 3 apical views add prognostic value to electrocardiographic criteria. There were 112 patients (55%) with GLS >−9% and 136 patients (66%) with GCS >−9%. During 4 years, 81 patients reached the combined primary end point (death, circulatory support, or transplant) and 120 reached the secondary end point (heart failure hospitalization or death). Both GLS >−9% and GCS >−9% were associated with increased risk of unfavorable events as follows: for the primary end point (hazard ratio=2.91; 95% confidence interval, 1.88–4.49;
P
<0.001) and (hazard ratio=3.73; 95% confidence interval, 2.39–5.82;
P
<0.001) for the secondary end point (hazard ratio=2.10; 95% confidence interval, 1.45–3.05;
P
<0.001) and (hazard ratio=3.25; 95% confidence interval, 2.23–4.75;
P
<0.001). In a prespecified subgroup of 120 patients with QRS 120 to 149 ms or non–left bundle branch block, significant associations of baseline GLS and GCS and outcomes remained:
P
=0.014 and
P
=0.002 for the primary end point and
P
=0.049 and
P
=0.001 for the secondary end point. Global strain measures had additive prognostic value to routine clinical or electrocardiographic parameters (
P
<0.001).
Conclusions—
Baseline GCS and GLS were significantly associated with long-term outcome after cardiac resynchronization therapy and had additive prognostic value to routine clinical and electrocardiographic selection criteria for cardiac resynchronization therapy.
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Affiliation(s)
| | | | | | - Keiko Ryo
- From the University of Pittsburgh, PA
| | | | | | - Zhi Qi
- From the University of Pittsburgh, PA
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Montecucco F, Carbone F, Schindler TH. Pathophysiology of ST-segment elevation myocardial infarction: novel mechanisms and treatments. Eur Heart J 2016; 37:1268-1283. [DOI: 10.1093/eurheartj/ehv592] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Gaemperli O, Delgado V, Habib G, Kaufmann PA, Bax JJ. The year in cardiology 2015: imaging. Arq Bras Cardiol 2016; 37:667-75. [PMID: 26726046 PMCID: PMC5102474 DOI: 10.1093/eurheartj/ehv732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/10/2015] [Indexed: 01/05/2023] Open
Affiliation(s)
| | - Victoria Delgado
- Heart Lung Centrum, Leiden University Medical Center, Albinusdreef 2, RC Leiden, 2300, The Netherlands
| | - Gilbert Habib
- Service de Cardiologie, C.H.U. De La Timone, Bd Jean Moulin, Marseille, France
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Jeroen J Bax
- Heart Lung Centrum, Leiden University Medical Center, Albinusdreef 2, RC Leiden, 2300, The Netherlands
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Affiliation(s)
- Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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39
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Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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Bax JJ, Delgado V, Achenbach S, Sechtem U, Knuuti J. Multimodality imaging: Bird's eye view from The European Society of Cardiology Congress 2015 London, August 29-September 2, 2015. J Nucl Cardiol 2015; 22:1171-8. [PMID: 26560330 PMCID: PMC4653228 DOI: 10.1007/s12350-015-0322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jeroen J Bax
- Department of Cardiology, Heart Lung Centrum, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centrum, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Stephan Achenbach
- Department of Cardiology, University Hospital Erlangen, Medizinische Klinik 2, Erlangen, Germany.
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany.
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland.
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