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Airale L, Vallelonga F, Forni T, Leone D, Magnino C, Avenatti E, Iannaccone A, Astarita A, Mingrone G, Cesareo M, Giordana C, Omedè P, Moretti C, Veglio F, Pedrizzetti G, Milan A. A Novel Approach to Left Ventricular Filling Pressure Assessment: The Role of Hemodynamic Forces Analysis. Front Cardiovasc Med 2021; 8:704909. [PMID: 34568448 PMCID: PMC8455914 DOI: 10.3389/fcvm.2021.704909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Diastolic function in patients with heart failure is usually impaired, resulting in increased left ventricular (LV) filling pressures, whose gold standard assessment is right heart catheterization (RHC). Hemodynamic force (HDF) analysis is a novel echocardiographic tool, providing an original approach to cardiac function assessment through the speckle-tracking technology. The aim of our study was to evaluate the use of HDFs, both alone and included in a new predictive model, as a potential novel diagnostic tool of the diastolic function. Methods: HDF analysis was retrospectively performed in 67 patients enrolled in the “Right1 study.” All patients underwent RHC and echocardiography up to 2 h apart. Increased LV filling pressure (ILFP) was defined as pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg. Results: Out of 67 patients, 33 (49.2%) showed ILFP at RHC. Diastolic longitudinal force (DLF), the mean amplitude of longitudinal forces during diastole, was associated with the presence of ILFP (OR = 0.84 [0.70; 0.99], p = 0.046). The PCWP prediction score we built including DLF, ejection fraction, left atrial enlargement, and e' septal showed an AUC of 0.83 [0.76–0.89], with an optimal internal validation. When applied to our population, the score showed a sensitivity of 72.7% and a specificity of 85.3%, which became 66.7 and 94.4%, respectively, when applied to patients classified with “indeterminate diastolic function” according to the current recommendations. Conclusion: HDF analysis could be an additional useful tool in diastolic function assessment. A scoring system including HDFs might improve echocardiographic accuracy in estimating LV filling pressures. Further carefully designed studies could be useful to clarify the additional value of this new technology.
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Affiliation(s)
- Lorenzo Airale
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Fabrizio Vallelonga
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Tommaso Forni
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Dario Leone
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Corrado Magnino
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Eleonora Avenatti
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Andrea Iannaccone
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Anna Astarita
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Giulia Mingrone
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Marco Cesareo
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Carlo Giordana
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Hemodynamic Laboratory, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Claudio Moretti
- Hemodynamic Laboratory, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Franco Veglio
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Alberto Milan
- Internal Medicine and Hypertension Division, Department of Medical Sciences, Azienda Ospedaliera Universitaria (AOU) "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
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Santini L, Forleo GB, Minni V, Mafhouz K, Della Rocca DG, Fresiello L, Romeo F, Ferrari G, Di Molfetta A. Towards a Personalized and Dynamic CRT-D. Methods Inf Med 2018; 51:495-506. [DOI: 10.3414/me12-01-0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/20/2012] [Indexed: 11/09/2022]
Abstract
SummaryBackground: In spite of cardiac resynchronization therapy (CRT) benefits, 25 – 30% of patients are still non responders. One of the possible reasons could be the non optimal atrioventricular (AV) and interventricular (VV) intervals settings. Our aim was to exploit a numerical model of cardiovascular system for AV and VV intervals optimization in CRT.Methods: A numerical model of the cardiovascular system CRT-dedicated was previously developed. Echocardiographic parameters, Systemic aortic pressure and ECG were collected in 20 consecutive patients before and after CRT. Patient data were simulated by the model that was used to optimize and set into the device the intervals at the baseline and at the follow up. The optimal AV and VV intervals were chosen to optimize the simulated selected variable/s on the base of both echocardiographic and electrocardiographic parameters.Results: Intervals were different for each patient and in most cases, they changed at follow up. The model can well reproduce clinical data as verified with Bland Altman analysis and T-test (p > 0.05). Left ventricular remodeling was 38.7% and left ventricular ejection fraction increasing was 11% against the 15% and 6% reported in literature, respectively.Conclusions: The developed numerical model could reproduce patients conditions at the baseline and at the follow up including the CRT effects. The model could be used to optimize AV and VV intervals at the baseline and at the follow up realizing a personalized and dynamic CRT. A patient tailored CRT could improve patients outcome in comparison to literature data.
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Höke U, Mertens B, Khidir MJH, Schalij MJ, Bax JJ, Delgado V, Ajmone Marsan N. Usefulness of the CRT-SCORE for Shared Decision Making in Cardiac Resynchronization Therapy in Patients With a Left Ventricular Ejection Fraction of ≤35. Am J Cardiol 2017; 120:2008-2016. [PMID: 29031415 DOI: 10.1016/j.amjcard.2017.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/30/2017] [Accepted: 08/01/2017] [Indexed: 01/31/2023]
Abstract
Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Our aim was to develop a multiparametric prognostic risk score (CRT-SCORE) that could be used for patient-specific clinical shared decision making about CRT implantation. The CRT-SCORE was derived from an ongoing CRT registry, including 1,053 consecutive patients (age 67 ± 10 years, 76% male). Using preimplantation variables, 100 multiple imputed datasets were generated for model calibration. Based on multivariate Cox regression models, cross-validated linear prognostic scores were calculated, as well as survival fractions at 1 and 5 years. Specifically, the CRT-SCORE was calculated using atrioventricular junction ablation, age, gender, etiology, New York Heart Association class, diabetes, hemoglobin level, renal function, left bundle branch block, QRS duration, atrial fibrillation, left ventricular systolic and diastolic functions, and mitral regurgitation, and showed a good discriminative ability (areas under the curve 0.773 at 1 year and 0.748 at 5 years). During the long-term follow-up (median 60 months, interquartile range 31 to 85), all-cause mortality was observed in 494 (47%) patients. Based on the distribution of the CRT-SCORE, lower- and higher-risk patient groups were identified. Estimated mean survival rates of 98% at 1 year and 92% at 5 years were observed in the lowest 5% risk group (L5 CRT-SCORE: -4.42 to -1.60), whereas the highest 5% risk group (H5 CRT-SCORE: 1.44 to 2.89) showed poor survival rates: 78% at 1 year and 22% at 5 years. In conclusion, the CRT-SCORE allows accurate prediction of 1- and 5-year survival rates after CRT using readily available and CRT-specific clinical, electrocardiographic, and echocardiographic parameters. The model may assist clinicians in counseling patients and in decision making.
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Affiliation(s)
- Ulas Höke
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Bart Mertens
- Medical Statistics Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Mand J H Khidir
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Höke U, Khidir MJH, van der Velde ET, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Cardiac Resynchronization Therapy in CKD Stage 4 Patients. Clin J Am Soc Nephrol 2015; 10:1740-8. [PMID: 26408549 DOI: 10.2215/cjn.00620115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 07/08/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cardiac resynchronization therapy (CRT) is a well established heart failure treatment that has shown to improve renal function. However, landmark CRT trials excluded patients with severe renal dysfunction. Therefore, this study evaluated the effect of CRT on renal function and long-term prognosis in patients with stage 4 CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study evaluated 73 consecutive CRT patients (71±10 years) with stage 4 CKD who underwent echocardiographic and renal function evaluation at baseline and 6-month follow-up between 2000 and 2012. As a control group, 18 patients with stage 4 CKD who received an implantable cardioverter defibrillator (ICD) were selected. CRT recipients with ≥15% reduction in left ventricular end-systolic volume at 6-month follow-up were classified as CRT responders. During long-term follow-up (median, 33 months), appropriate defibrillator therapy, heart failure hospitalizations, and all-cause mortality (combined end point) were recorded. RESULTS At 6-month follow-up, a significant reduction in left ventricular end-systolic volume was observed in CRT patients compared with patients with ICD (from 159±78 to 145±78 ml in CRT patients and from 126±54 to 119±49 ml in ICD patients; P=0.05), and CRT response was observed in 22 patients (30%). Compared with ICD patients, eGFR improved among CRT patients (from 25±4 to 30±9 ml/min per 1.73 m(2); interaction time and group, P=0.04) and was more pronounced among CRT responders (25±3 to 34±9 ml/min per 1.73 m(2); P<0.001). The combined end point was observed in 17 ICD and 62 CRT patients. CRT patients showed superior survival compared with ICD patients (log-rank P=0.03). More importantly, CRT response was independently associated with improved survival free from the combined end point (hazard ratio, 0.51; 95% confidence interval, 0.27 to 0.98; P=0.04) after adjustment for clinical and echocardiographic parameters. CONCLUSIONS Response to CRT occurs in approximately 30% of patients with stage 4 CKD, which is less than in the average CRT population. CRT was associated with better clinical outcome, and particularly, CRT response was associated with improvement in eGFR and better long-term prognosis.
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Affiliation(s)
- Ulas Höke
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
| | - Mand J H Khidir
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Enno T van der Velde
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
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Kato H, Shimano M, Sumi T, Murakami H, Kada K, Inden Y, Tsuboi N, Murohara T. Acute improvement of left ventricular relaxation as a predictor of volume reduction after cardiac resynchronization therapy: a pilot study assessing the value of left ventricular hemodynamic parameter. Pacing Clin Electrophysiol 2014; 37:1544-52. [PMID: 25113752 DOI: 10.1111/pace.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 05/31/2014] [Accepted: 06/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves cardiac function, but CRT recipients with advanced heart failure (HF) do not always respond well. Because the best parameters for the prediction of CRT response are not established, we investigated whether improvement of invasive left ventricular (LV) hemodynamic diastolic parameters could identify CRT responders. METHODS A total of 34 consecutive patients (age, 69 ± 9 years; 70% men) who received CRT devices for HF were assessed as to whether acute invasive hemodynamic parameters with and without CRT function could predict LV volume responders. RESULTS These patients demonstrated an improvement in LV dP/dtmax (11.1 ± 11.7%), LV dP/dtmin (4.6 ± 12.1%), and tau (3.7 ± 11.6%) by biventricular pacing. Nineteen patients (55%) were classified as CRT responders, which was defined by a >15% decrease in LV end-systolic volume (ESV) at the 6-month follow-up evaluation. The area under the receiver operator characteristic curve to detect CRT volume response was 0.93 for the shortening of tau, which was superior to any other hemodynamic parameter. The multivariate analysis revealed that this improvement in tau was the strongest predictive factor for identifying CRT volume responders. Of note, the magnitude of tau shortening during biventricular pacing was significantly correlated with the reduction in LVESV at the 6-month follow-up evaluation. CONCLUSIONS The extent of acute improvement in LV isovolumic relaxation time, as assessed by tau, was associated with favorable response to CRT. The assessment of invasive diastolic function could provide valuable information about CRT volume response.
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Affiliation(s)
- Hiroyuki Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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Systolic heart failure and cardiac resynchronization therapy: a focus on diastole. Int J Cardiovasc Imaging 2014; 30:897-905. [PMID: 24706254 PMCID: PMC4008775 DOI: 10.1007/s10554-014-0412-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/25/2014] [Indexed: 11/03/2022]
Abstract
Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aim of the study was to assess if and how CRT affects DF in systolic heart failure patients. We also investigated potential relations between CRT-induced left ventricular changes and the composite clinical endpoint of progressive heart failure and cardiac death over 3 years follow-up. 119 CRT patients underwent clinical evaluation and echocardiography before CRT and 4 months later. DF was quantified by transmitral velocities [E/A waves, deceleration time (DT), E/DT], early diastolic mitral annulus velocity (E'), E/E' ratio and 2-D speckle tracking strain rate during isovolumetric relaxation (IVR, SRivr). End-diastolic pressure-volume relationship (EDPVR) was also assessed noninvasively using a single-beat method. Overall stiffness was quantified by ventricular stiffness (Klv) normalized to end-diastolic volume (EDV). New York Heart Association class improved at 4 months (from 2.7 ± 0.7 to 1.9 ± 0.6, p < 0.001) as did ventricular filling (E/DT from 0.48 ± 0.29 to 0.39 ± 0.31 cm/s(2), p = 0.01). In contrast, relaxation (E', SRivr) and filling pressures (E/E', E/SRivr) did not change. Slope of EDPVR did not change with CRT. Such finding, together with an unmodified Klv/EDV and a 7 ± 18 % reduction in EDV (p = 0.001), suggested reverse remodelling towards a smaller equilibrium volume. Finally, end-systolic LV volume decreased from 147 ± 59 to 125 ± 52 ml and ejection fraction increased from 0.26 ± 0.07 to 0.32 ± 0.09 (both p < 0.001). Using a Cox regression model we found that only changes (Δ) in diastolic, but not systolic indexes, correlated with the composite clinical endpoint, with increments in ΔEDV20 and ΔE/DT, single or combined, greatly increasing risk of heart failure and/or cardiac death (p = 0.003). Ventricular reverse remodelling, together with improvement in ventricular filling, rather than improvements of systolic function, predict clinical prognosis long-term post-CRT.
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Pappone C, Ćalović Ž, Vicedomini G, Cuko A, McSpadden LC, Ryu K, Romano E, Saviano M, Baldi M, Pappone A, Ciaccio C, Giannelli L, Ionescu B, Petretta A, Vitale R, Fundaliotis A, Tavazzi L, Santinelli V. Multipoint left ventricular pacing improves acute hemodynamic response assessed with pressure-volume loops in cardiac resynchronization therapy patients. Heart Rhythm 2014; 11:394-401. [DOI: 10.1016/j.hrthm.2013.11.023] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Indexed: 11/29/2022]
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Gabrielli L, Sitges M, Mont L. Assessing reverse remodeling in heart failure patients treated with cardiac resynchronization therapy and its impact on prognosis. Expert Rev Cardiovasc Ther 2014; 10:1437-48. [DOI: 10.1586/erc.12.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Egnaczyk GF, Chung ES. The Relationship Between Cardiac Resynchronization Therapy and Diastolic Function. Curr Heart Fail Rep 2013; 11:64-9. [DOI: 10.1007/s11897-013-0181-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Doltra A, Bijnens B, Tolosana JM, Gabrielli L, Castel MÁ, Berruezo A, Brugada J, Mont L, Sitges M. Effect of Cardiac Resynchronization Therapy on Left Ventricular Diastolic Function: Implications for Clinical Outcome. J Card Fail 2013; 19:795-801. [DOI: 10.1016/j.cardfail.2013.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/25/2013] [Accepted: 11/04/2013] [Indexed: 11/26/2022]
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Verbrugge FH, Verhaert D, Grieten L, Dupont M, Rivero-Ayerza M, De Vusser P, Van Herendael H, Reyskens R, Vandervoort P, Tang WHW, Mullens W. Revisiting diastolic filling time as mechanistic insight for response to cardiac resynchronization therapy. ACTA ACUST UNITED AC 2013; 15:1747-56. [DOI: 10.1093/europace/eut130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Höke U, Thijssen J, van Bommel RJ, van Erven L, van der Velde ET, Holman ER, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Influence of diabetes on left ventricular systolic and diastolic function and on long-term outcome after cardiac resynchronization therapy. Diabetes Care 2013; 36:985-91. [PMID: 23223348 PMCID: PMC3609501 DOI: 10.2337/dc12-1116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The influence of diabetes on cardiac resynchronization therapy (CRT) remains unclear. The aims of the current study were to 1) assess the changes in left ventricular (LV) systolic and diastolic function and 2) evaluate long-term prognosis in CRT recipients with diabetes. RESEARCH DESIGN AND METHODS A total of 710 CRT recipients (171 with diabetes) were included from an ongoing registry. Echocardiographic evaluation, including LV systolic and diastolic function assessment, was performed at baseline and 6-month follow-up. Response to CRT was defined as a reduction of ≥15% in LV end-systolic volume (LVESV) at the 6-month follow-up. During long-term follow-up (median = 38 months), all-cause mortality (primary end point) and cardiac death or heart failure hospitalization (secondary end point) were recorded. RESULTS At the 6-month follow-up, significant LV reverse remodeling was observed both in diabetic and non-diabetic patients. However, the response to CRT occurred more frequently in non-diabetic patients than in diabetic patients (57 vs. 45%, P < 0.05). Furthermore, a significant improvement in LV diastolic function was observed both in diabetic and non-diabetic patients, but was more pronounced in non-diabetic patients. The determinants of the response to CRT among diabetic patients were LV dyssynchrony, ischemic cardiomyopathy, and insulin use. Both primary and secondary end points were more frequent in diabetic patients (P < 0.001). Particularly, diabetes was independently associated with all-cause mortality together with ischemic cardiomyopathy, renal function, LVESV, LV dyssynchrony, and LV diastolic dysfunction. CONCLUSIONS Heart failure patients with diabetes exhibit significant improvements in LV systolic and diastolic function after CRT, although they are less pronounced than in non-diabetic patients. Diabetes was independently associated with all-cause mortality.
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Affiliation(s)
- Ulas Höke
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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Valenti V, Zia MI, Shubayev L, Edelstein S, Supariwala A, Uretsky S, Fantozzi LM, Volpe M, Sciarretta S, Wolff SD. Cardiac magnetic resonance evaluation of the impact of interventricular and intraventricular dyssynchrony on cardiac ventricular systolic and diastolic function in patients with isolated left bundle branch block. Am J Cardiol 2012; 110:1651-6. [PMID: 22921998 DOI: 10.1016/j.amjcard.2012.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 07/23/2012] [Accepted: 07/23/2012] [Indexed: 11/29/2022]
Abstract
Ventricular dyssynchrony significantly impairs cardiac performance. However, the independent role of interventricular dyssynchrony (interVD) and intraventricular dyssynchrony (intraVD) in the development of abnormalities of systolic and diastolic performance is unclear. Cardiac magnetic resonance imaging was performed in 39 patients with left bundle branch block and 13 healthy patients. Structural and functional parameters of the left ventricle and degrees of interVD and intraVD were measured. We found that interVD was inversely correlated with left ventricular (LV) ejection fraction (r = -0.8, p <0.0001) and positively correlated with LV end-diastolic volume (r = 0.4, p <0.01), LV end-systolic volume (r = 0.6, p <0.0001), and LV mass (r = 0.4, p <0.01), thus indicating that interVD significantly affects systolic function and favors ventricular remodeling. Multivariate analysis further confirmed that interVD was an independent predictor of systolic dysfunction. Interestingly, we found that interVD was not associated with abnormalities of diastolic performance. Conversely, we found that intraVD significantly impaired diastolic function, whereas it had no effect on systolic function. IntraVD was inversely correlated with peak filling rate (r = -0.7, p <0.0001) and 1/2 filling fraction (r = 0.4, p = 0.04) and positively correlated with time to peak filling rate (r = 0.6, p <0.0001), validated parameters of diastolic function. Multivariate analysis confirmed that intraVD was an independent predictor of diastolic dysfunction. In conclusion, our study suggests that the 2 components of ventricular dyssynchrony differently affect cardiac performance. If confirmed in prospective studies, our results may help to predict the prognosis of patients with left bundle branch block and different degrees of interVD and intraVD, particularly those subjects undergoing cardiac resynchronization therapy.
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Affiliation(s)
- Valentina Valenti
- Advanced Cardiovascular Imaging, Department of Radiology, Columbia University Medical Center, New York, New York, USA.
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Sullivan RM, Murillo J, Gerritse B, Chung E, Orlov MV, Stegemann B, Fedewa M, Peterson BJ, Sun JP, Olshansky B. Do baseline diastolic echocardiographic parameters predict outcome after resynchronization therapy? Results from the PROSPECT trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:214-20. [PMID: 23121136 DOI: 10.1111/pace.12042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/14/2012] [Accepted: 08/27/2012] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) can improve clinical and cardiac structural status in heart failure patients. The role of baseline diastolic echocardiographic parameters to characterize the likelihood of positive outcomes is not well known. We explored relationships between diastolic parameters and outcomes 6 months after CRT implant in the Predictors of Response to CRT (PROSPECT) Trial. HYPOTHESIS We hypothesized that diastolic echocardiographic parameters were associated with clinical and structural outcomes in CRT patients. METHODS For 426 patients in PROSPECT, a prospective observational trial of CRT, baseline E/A ratio, left atrial (LA) area, isovolumic relaxation time, left ventricular inflow deceleration time, E' velocity, and E/E' ratio were evaluated and related to 6-month clinical composite score (CCS) and left ventricular end-systolic volume (LVESV) reduction using Spearman rank-order correlations. Parameters associated with outcomes were analyzed further by discrete categorization. RESULTS As continuous variables, only E/A ratio and LA area correlated with CCSs (P = 0.017, P = 0.045, respectively) and relative change in LVESV at 6 months (P < 0.0001, P = 0.001, respectively). As discrete variables, E/A ratio and LA area also correlated with CCSs and LVESV. CONCLUSION Diastolic echo parameters E/A ratio and LA area were associated with clinical and structural outcomes in CRT patients at 6 months.
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Affiliation(s)
- Renee M Sullivan
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
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