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Padeletti L, Modesti PA, Cartei S, Checchi L, Ricciardi G, Pieragnolia P, Sacchi S, Padeletti M, Alterini B, Pantaleo P, Hu X, Tenori L, Luchinat C. Metabolomic does not predict response to cardiac resynchronization therapy in patients with heart failure. J Cardiovasc Med (Hagerstown) 2014; 15:295-300. [PMID: 24699011 DOI: 10.2459/jcm.0000000000000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS Metabolomic, a systematic study of metabolites, may be a useful tool in understanding the pathological processes that underlie the occurrence and progression of a disease. We hypothesized that metabolomic would be helpful in assessing a specific pattern in heart failure patients, also according to the underlining causes and in defining, prior to device implantation, the responder and nonresponder patient to cardiac resynchronization therapy (CRT). METHODS In this prospective study, blood and urine samples were collected from 32 heart failure patients who underwent CRT. Clinical, electrocardiography and echocardiographic evaluation was performed in each patient before CRT and after 6 months of follow-up. Thirty-nine age and sex-matched healthy individuals were chosen as control group. For each sample, 1H-NMR spectra, Nuclear Overhauser Enhancement Spectroscopy, Carr-Purcell-Meiboom-Gill and diffusion edited spectra were measured. RESULTS A different metabolomic fingerprint was demonstrated in heart failure patients compared to healthy controls with high accuracy level. Metabolomics fingerprint was similar between patients with ischemic and nonischemic dilated cardiomyopathy. At 6-month follow-up, metabolomic fingerprint was different from baseline. At follow-up, heart failure patients’ metabolomic fingerprint remained significantly different from that of healthy controls, and accuracy of cause discrimination remained low. Responders and nonresponders had a similar metabolic fingerprint at baseline and after 6 months of CRT. CONCLUSION It is possible to identify a metabolomic fingerprint characterizing heart failure patients candidate to CRT, it is independent of the different causes of the disease and it is not predictive of the response to CRT.
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Attanà P, Paoletti Perini A, Votta CD, Cappelli F, Pieragnoli P, Ricciardi G, Nesti M, Giomi A, Sacchi S, Chiostri M, Padeletti L. QRS duration in left bundle branch block does not affect left ventricular twisting in chronic systolic heart failure. Clin Physiol Funct Imaging 2014; 35:436-42. [PMID: 25077412 DOI: 10.1111/cpf.12181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/24/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Left ventricular (LV) torsion is an important parameter of LV performance and can be influenced by several factors. Aim of this investigation was to evaluate whether QRS prolongation in left bundle branch block (LBBB) may influence global LV twist and twisting/untwisting rate in chronic systolic heart failure (HF) patients. METHODS We prospectively evaluated 30 healthy subjects (control group) and 100 chronic HF patients with severely impaired LV systolic function (ejection fraction ≤ 35%). Patients were divided into three groups according to QRS duration: A: QRS < 120 ms (n 49), B: 120 ≤ QRS ≤ 150 ms (n 28) and C: QRS > 150 ms (n 23). Patients in groups B and C presented LBBB. All subjects underwent standard trans-thoracic echocardiography and two-dimensional speckle-tracking echocardiography evaluation. Categorical variables were compared by the chi-square or the Fisher's exact test. Continuous variables were compared using the ANOVA test. Correlations between variables were analysed with linear regression. RESULTS Control subjects presented higher torsion parameters, when compared with patients in any HF group. Among the three HF groups, no differences were detected in global twist (4.79 ± 3.54, 3.8 ± 3.0 and 4.15 ± 3.14 degrees, respectively), twist rate max (44.81 ± 25.03, 37.94 ± 19.09 and 37.61 ± 24.49 degrees s(-1), respectively) and untwist rate max (-36.31 ± 30.89, -27.68 ± 34.67 and -39.62 ± 26.27 degrees s(-1), respectively) (P>0.05 for all). At linear regression analysis, there was no relation between QRS duration and any torsion parameter (P>0.05 for all). CONCLUSIONS In patients with chronic severe systolic heart failure, QRS duration and LBBB morphology do not affect LV twisting and untwisting.
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Affiliation(s)
- Paola Attanà
- Dipartimento Cuore e Vasi, Università degli Studi, Firenze, Italia
| | | | | | | | - Paolo Pieragnoli
- Dipartimento Cuore e Vasi, Università degli Studi, Firenze, Italia
| | | | - Martina Nesti
- Dipartimento Cuore e Vasi, Università degli Studi, Firenze, Italia
| | - Andrea Giomi
- Dipartimento Cuore e Vasi, Università degli Studi, Firenze, Italia
| | - Stefania Sacchi
- Dipartimento Cuore e Vasi, Università degli Studi, Firenze, Italia
| | - Marco Chiostri
- Dipartimento Cuore e Vasi, Università degli Studi, Firenze, Italia
| | - Luigi Padeletti
- Dipartimento Cuore e Vasi, Università degli Studi, Firenze, Italia.,Cliniche Humanitas Gavazzeni, Bergamo, Italia
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Abstract
Cardiac resynchronization therapy reduces mortality and morbidity in heart failure patients with wide QRS and severe impairment of left ventricular systolic function, who are symptomatic despite optimal medical therapy. However, a high percentage of patients fail to show clinical or echocardiographic response to this treatment. Beyond current selection criteria, other elements, such as QRS duration and morphology, concomitant medical therapy, degree of right ventricle dysfunction, myocardial viability, presence of left ventricular dyssynchrony, and associated renal dysfunction, play a crucial role in modulating the response to cardiac resynchronization. Consequently, they should be part of the standard pre-implant evaluation, as they could be used to identify patients who are very unlikely to be responders.
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Hotta VT, Martinelli Filho M, Mathias W, Vieira MLC. New equation for prediction of reverse remodeling after cardiac resynchronization therapy. Echocardiography 2012; 29:678-87. [PMID: 22348339 DOI: 10.1111/j.1540-8175.2011.01658.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To integrate data from two-dimensional echocardiography (2D ECHO), three-dimensional echocardiography (3D ECHO), and tissue Doppler imaging (TDI) for prediction of left ventricular (LV) reverse remodeling (LVRR) after cardiac resynchronization therapy (CRT). It was also compared the evaluation of cardiac dyssynchrony by TDI and 3D ECHO. METHODS Twenty-four consecutive patients with heart failure, sinus rhythm, QRS ≥ 120 msec, functional class III or IV and LV ejection fraction (LVEF) ≤ 0.35 underwent CRT. 2D ECHO, 3D ECHO with systolic dyssynchrony index (SDI) analysis, and TDI were performed before, 3 and 6 months after CRT. Cardiac dyssynchrony analyses by TDI and SDI were compared with the Pearson's correlation test. Before CRT, a univariate analysis of baseline characteristics was performed for the construction of a logistic regression model to identify the best predictors of LVRR. RESULTS After 3 months of CRT, there was a moderate correlation between TDI and SDI (r = 0.52). At other time points, there was no strong correlation. Nine of twenty-four (38%) patients presented with LVRR 6 months after CRT. After logistic regression analysis, SDI (SDI > 11%) was the only independent factor in the prediction of LVRR 6 months of CRT (sensitivity = 0.89 and specificity = 0.73). After construction of receiver operator characteristic (ROC) curves, an equation was established to predict LVRR: LVRR =-0.4LVDD (mm) + 0.5LVEF (%) + 1.1SDI (%), with responders presenting values >0 (sensitivity = 0.67 and specificity = 0.87). CONCLUSIONS In this study, there was no strong correlation between TDI and SDI. An equation is proposed for the prediction of LVRR after CRT. Although larger trials are needed to validate these findings, this equation may be useful to candidates for CRT.
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Porciani MC, Ricceri I, Attanà P, Pennesi M, Michelotti F, Mascia G, Sacchi S, Hashtroudi L, Padeletti L. Discordant electrical and mechanical atrial delays affect intracavitary electrogram-based cardiac resynchronization therapy optimization. Europace 2011; 14:593-8. [PMID: 22041885 DOI: 10.1093/europace/eur335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS It has been shown that atrioventricular (AV) delay optimization improves cardiac resynchronization therapy (CRT) response. Recently, an automatic algorithm (QuickOpt™, St Jude Medical), able to quickly identify the individual optimal AV interval, has been developed. The algorithm suggests an AV delay based on atrial intracavitary electrogram (IEGM) duration. We hypothesized that the difference between electrical and mechanical atrial delays could affect the effectiveness of QuickOpt method. The aim of this study was to test this hypothesis in 23 CRT patients who were recipients of St. Jude Medical devices. METHODS AND RESULTS Using echocardiography, aortic flow velocity time integral (VTI) was evaluated at baseline, at QuickOpt suggested AV delay and after reducing it by 25 and 50%. Mechanical inter-atrial delay (MIAD) derived from echo/Doppler and electrical inter-atrial delay (EIAD) derived from IEGM were also analysed. Optimal AV delay was identified by the maximal VTI. In 11 patients (Group 1) the maximal VTI was achieved at the AV delay suggested by the algorithm, in 6 patients (Group 2) after a 25% reduction, and in 6 patients (Group 3) after a 50% reduction. While EIAD was similar among the three groups, MIAD was significantly different (P< 0.001). MIAD was longer than EIAD in Group 1 (P= 0.028) and shorter than EIAD in Groups 2 (P= 0.028) and 3. (P< 0.001). Mechanical inter-atrial delay was the only independent predictor of the AV interval associated with the best VTI (R(2) = 0.77; P< 0.001). CONCLUSION Our results show that MIAD plays the main role in determining the optimal AV delay, thus caution should be taken when optimizing AV by IEGM-based methods.
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Affiliation(s)
- Maria Cristina Porciani
- Department of Medical and Surgical Critical Care, University of Florence, Viale Morgagni 85, Florence, Italy.
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Ito T, Kawanishi Y, Tsukada B, Umeda T, Suwa M, Terasaki F, Ishizaka N. A Display of Combined Left Ventricular Function and Dyssynchrony Using Doppler Tissue Imaging: Its Application in Acute Response to Cardiac Resynchronization Therapy. Echocardiography 2011; 28:870-6. [DOI: 10.1111/j.1540-8175.2011.01442.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Li Y, Garson CD, Xu Y, Helm PA, Hossack JA, French BA. Serial ultrasound evaluation of intramyocardial strain after reperfused myocardial infarction reveals that remote zone dyssynchrony develops in concert with left ventricular remodeling. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1073-1086. [PMID: 21640480 PMCID: PMC3119373 DOI: 10.1016/j.ultrasmedbio.2011.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 03/14/2011] [Accepted: 04/04/2011] [Indexed: 05/30/2023]
Abstract
This study noninvasively evaluated the development of left ventricular (LV) dyssynchrony following reperfused myocardial infarction (MI) in mice using an ultrasonic speckle-tracking method. Eight C57BL/6J mice were assessed by high-resolution echocardiography at baseline and at eight time-points following MI. Images were acquired at 1mm elevational intervals encompassing the entire LV to determine chamber volumes and radial strain. Receiver-operating characteristic (ROC) analysis of regional radial strain was used to segment the three-dimensional (3-D) LV into infarct, adjacent and remote zones. This in vivo segmentation was correlated to histologic infarct size (R = 0.89, p < 0.01) in a short-axis, slice-by-slice comparison. The onset of dyssynchrony during LV remodeling was assessed by standard deviation of time to peak radial strain in the infarct, adjacent and remote zones. It was discovered that the form of LV dyssynchrony that develops in the remote zone late after MI does so in concert with the progression of LV remodeling (R = 0.70, p < 0.05).
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Affiliation(s)
- Yinbo Li
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Christopher D. Garson
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Yaqin Xu
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | | | - John A. Hossack
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Brent A. French
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
- Radiology, University of Virginia, Charlottesville, VA, USA
- Medicine, University of Virginia, Charlottesville, VA, USA
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Zhang Q, Yu CM. Is mechanical dyssynchrony still a major determinant for responses after cardiac resynchronization therapy? J Cardiol 2011; 57:239-48. [DOI: 10.1016/j.jjcc.2011.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/10/2011] [Indexed: 11/29/2022]
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