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Saffi H, Winsløw U, Sakthivel T, Højgaard EV, Linde J, Philbert B, Vinther M, Jøns C, Bundgaard H, Risum N. Global constructive work is associated with ventricular arrhythmias after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2023; 25:29-36. [PMID: 37490039 DOI: 10.1093/ehjci/jead180] [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: 11/24/2022] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
AIMS Non-invasive left ventricular (LV) pressure-strain loops provide a novel method for quantifying myocardial work by incorporating LV pressure in measurements of myocardial deformation. Early studies suggest that myocardial work parameters such as global constructive work (GCW) could be useful and reliable in arrhythmia prediction, particularly in patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to evaluate whether the magnitude of GCW was associated with the occurrence of ventricular arrhythmias in patients after CRT. METHODS AND RESULTS Patients on guideline-recommended treatment with a CRT defibrillator (CRT-D) were evaluated by 2D speckle-tracking echocardiography including measurements of GCW at least 6 months after implantation. The primary outcome was a composite of appropriate defibrillator therapy and sustained ventricular arrhythmia under the monitor zone. A total of 162 patients [mean age 66 years (±10), 122 males (75%)] were included. Sixteen (10%) patients experienced the primary outcome during a median follow-up of 18 months (interquartile range: 12-25) after the performance of index echocardiography. Patients with a below-median GCW (<1473 mmHg%) had a hazard ratio (HR) for the outcome of 8.14 [95% confidence interval (CI): 1.83-36.08], P = 0.006 compared with patients above the median in a univariate model and remained an independent predictor after multivariate adjustment for the estimated glomerular filtration rate and QRS duration [HR 4.75 (95% CI: 1.01-22.28), P < 0.05]. CONCLUSION In patients treated with CRT-D, a GCW below median level was associated with a five-fold increase in the risk of ventricular arrhythmias.
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Affiliation(s)
- Hillah Saffi
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ulrik Winsløw
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tharsika Sakthivel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Emma Vinther Højgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper Linde
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Berit Philbert
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Michael Vinther
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Borgquist R, Mörtsell D, Chaudhry U, Brandt J, Farouq M, Wang L. Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms. Heart Rhythm O2 2022; 3:457-463. [DOI: 10.1016/j.hroo.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 01/26/2023] Open
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Averbuch T, Sullivan K, Sauer A, Mamas MA, Voors AA, Gale CP, Metra M, Ravindra N, Van Spall HGC. Applications of artificial intelligence and machine learning in heart failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:311-322. [PMID: 36713018 PMCID: PMC9707916 DOI: 10.1093/ehjdh/ztac025] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Machine learning (ML) is a sub-field of artificial intelligence that uses computer algorithms to extract patterns from raw data, acquire knowledge without human input, and apply this knowledge for various tasks. Traditional statistical methods that classify or regress data have limited capacity to handle large datasets that have a low signal-to-noise ratio. In contrast to traditional models, ML relies on fewer assumptions, can handle larger and more complex datasets, and does not require predictors or interactions to be pre-specified, allowing for novel relationships to be detected. In this review, we discuss the rationale for the use and applications of ML in heart failure, including disease classification, early diagnosis, early detection of decompensation, risk stratification, optimal titration of medical therapy, effective patient selection for devices, and clinical trial recruitment. We discuss how ML can be used to expedite implementation and close healthcare gaps in learning healthcare systems. We review the limitations of ML, including opaque logic and unreliable model performance in the setting of data errors or data shift. Whilst ML has great potential to improve clinical care and research in HF, the applications must be externally validated in prospective studies for broad uptake to occur.
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Affiliation(s)
- Tauben Averbuch
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kristen Sullivan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Sauer
- Department of Cardiology, University of Kansas Health System, Kansas City, KS, USA
| | - Mamas A Mamas
- Keele Cardiovascular research group, Keele University, Stoke on Trent, Staffordshire
| | | | - Chris P Gale
- Department of Cardiology, University of Leeds, Leeds, West Yorkshire
| | - Marco Metra
- Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Neal Ravindra
- Department of Computer Science, Yale University, New Haven, CT, USA
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Asgardoon MH, Vasheghani-Farahani A, Sherafati A. Usefulness of Biomarkers for Predicting Response to Cardiac Resynchronization Therapy. Curr Cardiol Rev 2019; 16:132-140. [PMID: 31822259 PMCID: PMC7460709 DOI: 10.2174/1573403x15666191206163846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/08/2019] [Accepted: 11/16/2019] [Indexed: 01/08/2023] Open
Abstract
Cardiac Resynchronization Therapy (CRT) is an effective treatment strategy for heart failure. It significantly improves clinical symptoms and decreases mortality and long-term morbidity. However, some patients do not respond properly to this treatment. In this review, the role of different biomarkers in predicting response to CRT is discussed. Some biomarkers, including natriuretic peptides and inflammatory markers have promising results but further trials are needed for more evaluation.
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Affiliation(s)
- Mohammad H Asgardoon
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Student Society for Immunodeficiencies, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alborz Sherafati
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Roubicek T, Stros J, Kucera P, Nedbal P, Cerny J, Polasek R, Wichterle D. Combination of left ventricular reverse remodeling and brain natriuretic peptide level at one year after cardiac resynchronization therapy predicts long-term clinical outcome. PLoS One 2019; 14:e0219966. [PMID: 31314790 PMCID: PMC6636764 DOI: 10.1371/journal.pone.0219966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/06/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction The aim of this study was to investigate the predictors of long-term clinical outcome of heart failure (HF) patients who survived first year after initiation of cardiac resynchronization therapy (CRT). Methods This was a single-center observational cohort study of CRT patients implanted because of symptomatic HF with reduced ejection fraction between 2005 and 2013. Left ventricle (LV) diameters and ejection fraction, New York Heart Association (NYHA) class, and level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) were assessed at baseline and 12 months after CRT implantation. Their predictive power for long-term HF hospitalization and mortality, and cardiac and all-cause mortality was investigated. Results A total of 315 patients with left bundle branch block or intraventricular conduction delay who survived >1 year after CRT implantation were analyzed in the current study. During a follow-up period of 4.8±2.1 years from CRT implantation, 35.2% patients died from cardiac (19.3%) or non-cardiac (15.9%) causes. Post-CRT LV ejection fraction and LV end-systolic diameter (either 12-month value or the change from baseline) were equally predictive for clinical events. For NT-proBNP, however, the 12-month level was a stronger predictor than the change from baseline. Both reverse LV remodeling and 12-month level of NT-proBNP were independent and comparable predictors of CRT-related clinical outcome, while NT-proBNP response had the strongest association with all-cause mortality. When post-CRT relative change of LV end-systolic diameter and 12-month level of NT-proBNP (dichotomized at -12.3% and 1230 ng/L, respectively) were combined, subgroups of very-high and very-low risk patients were identified. Conclusion The level of NT-proBNP and reverse LV remodeling at one year after CRT are independent and complementary predictors of future clinical events. Their combination may help to improve the risk stratification of CRT patients.
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Affiliation(s)
- Tomas Roubicek
- Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Faculty of Health Studies, Technical University of Liberec, Liberec, Czech Republic
- * E-mail:
| | - Jan Stros
- Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Pavel Kucera
- Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Pavel Nedbal
- Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Jan Cerny
- Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Rostislav Polasek
- Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic
- Faculty of Health Studies, Technical University of Liberec, Liberec, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Faculty of Health Studies, Technical University of Liberec, Liberec, Czech Republic
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Impact of cardiac resynchronization therapy on inflammatory biomarkers and cardiac remodeling: The paradox of functional and echocardiographic response. Rev Port Cardiol 2018; 37:105-113. [PMID: 29503051 DOI: 10.1016/j.repc.2017.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/26/2017] [Accepted: 06/29/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Response to cardiac resynchronization therapy (CRT) can currently be assessed by clinical or echocardiographic criteria, and there is no strong evidence supporting the use of one rather than the other. Reductions in B-type natriuretic peptide (BNP) and C-reactive protein (CRP) have been shown to be associated with CRT response. This study aims to assess variation in BNP and CRP six months after CRT and to correlate this variation with criteria of functional and echocardiographic response. METHODS Patients undergoing CRT were prospectively enrolled between 2011 and 2014. CRT response was defined by echocardiography (15% reduction in left ventricular end-systolic volume) and by cardiopulmonary exercise testing (10% increase in peak oxygen consumption) from baseline to six months after device implantation. RESULTS A total of 115 patients were enrolled (68.7% male, mean age 68.6±10.5 years). Echocardiographic response was seen in 51.4% and 59.2% were functional responders. There was no statistical correlation between the two. Functional response was associated with a significantly greater reduction in BNP (-167.6±264.1 vs. -24.9±269.4 pg/ml; p=0.044) and CRP levels (-1.6±4.4 vs. 2.4±9.9 mg/l; p=0.04). Nonetheless, a non-significant reduction in BNP and CRP was observed in echocardiographic responders (BNP -144.7±260.2 vs. -66.1±538.2 pg/ml and CRP -7.1±24.3 vs. 0.8±10.3 mg/l; p>0.05). CONCLUSION An increase in exercise capacity after CRT implantation is associated with improvement in myocardial remodeling and inflammatory biomarkers. This finding highlights the importance of improvement in functional capacity after CRT implantation, not commonly considered a criterion of CRT response.
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Almeida-Morais L, Abreu A, Oliveira M, Silva Cunha P, Rodrigues I, Portugal G, Rio P, Soares R, Mota Carmo M, Cruz Ferreira R. Impact of cardiac resynchronization therapy on inflammatory biomarkers and cardiac remodeling: The paradox of functional and echocardiographic response. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gielgens R, Herold I, van Straten A, van Gelder B, Bracke F, Korsten H, Soliman Hamad M, Bouwman R. The Hemodynamic Effects of Different Pacing Modalities After Cardiopulmonary Bypass in Patients With Reduced Left Ventricular Function. J Cardiothorac Vasc Anesth 2018; 32:259-266. [DOI: 10.1053/j.jvca.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 11/11/2022]
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Long-Term Survival of Patients With Left Bundle Branch Block Who Are Hypo-Responders to Cardiac Resynchronization Therapy. Am J Cardiol 2017; 120:825-830. [PMID: 28688704 DOI: 10.1016/j.amjcard.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/17/2017] [Accepted: 06/05/2017] [Indexed: 11/24/2022]
Abstract
Guidelines support cardiac resynchronization therapy with a defibrillator (CRT-D) in mild heart failure (HF) patients with left bundle branch block (LBBB). However, not all patients demonstrate echocardiographic or clinical response to CRT-D. We aimed to evaluate the long-term outcomes of echocardiographic hypo-responders and clinical hypo-responders to CRT-D with LBBB in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy. Five-hundred thirty-four patients with LBBB in the CRT-D arm were followed for 5.6 years (median). Clinical hypo-response was defined as HF event in the first year after CRT-D implantation. Echocardiographic hypo-response was defined as ≤35% reduction (median) in left ventricular end-systolic volume 1 year after CRT-D implantation without evidence of clinical hypo-response. Echocardiographic and clinical response was observed in 257 patients (48%). Two-hundred fifty patients (47%) were echocardiographic hypo-responders and 27 patients (5%) were clinical hypo-responders. Echocardiographic hypo-responders had increased risk of all-cause mortality compared with echocardiographic + clinical responders (hazard ratio [HR] 2.85, 95% confidence interval [CI]: 1.37 to 5.94, p = 0.005). Clinical hypo-responders had increased risk of mortality compared with echocardiographic + clinical responders (HR 7.49, 95% CI: 2.88 to 19.48, p <0.0001) and compared with echocardiographic hypo-responders (HR 2.63, 95% CI: 1.17 to 5.92, p = 0.020). In conclusion, during long-term follow-up, patients with mild HF and LBBB who have echocardiographic hypo-response to CRT, with or without clinical signs of worsening HF, have increased risk of mortality. This study emphasizes the prognostic significance of echocardiographic assessment of left ventricular volume after CRT implantation in LBBB patients with mild HF.
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Rickard J, Wilkoff BL. Bridging the gap between heart failure and the device clinic. Expert Rev Med Devices 2017; 14:601-607. [PMID: 28699408 DOI: 10.1080/17434440.2017.1355234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION While cardiac resynchronization therapy (CRT) is a mainstay in the management of selected patients with chronic systolic dysfunction, many patients are noted to experience less than expected or no benefit at all from the therapy. Multidisciplinary care has been shown to provide benefit in follow up for patients receiving CRT devices. Areas covered: This review will focus on the apparent reasons behind less than optimal outcomes following CRT as well as multidisciplinary approaches to treating patients with CRT devices. The literature review focused mainly on the data behind multidisciplinary care of CRT patients. Expert commentary: A multidisciplinary approach incorporating input from various cardiology backgrounds is an important strategy in ensuring optimal outcomes in patients receiving CRT devices. Breaking down the 'silo' effect amongst cardiac subspecialties is vital in achieving high level multidisciplinary care.
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Affiliation(s)
- John Rickard
- a Division of Cardiovascular Medicine , Heart and Vascular Institute, Cleveland Clinic Cleveland , Ohio , USA
| | - Bruce L Wilkoff
- a Division of Cardiovascular Medicine , Heart and Vascular Institute, Cleveland Clinic Cleveland , Ohio , USA
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Warriner DR, Lawford P, Sheridan PJ. Cardiac Resynchronization Therapy Leads to Improvements in Handgrip Strength. Cardiol Res 2017; 7:95-103. [PMID: 28197275 PMCID: PMC5295515 DOI: 10.14740/cr475w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/11/2022] Open
Abstract
Background A reduction in skeletal muscle performance measured by handgrip strength is common in heart failure. No trial has investigated the role of cardiac resynchronization therapy, which leads to improvements in cardiac performance, on the function of skeletal muscle in patients with heart failure. Methods Nineteen patients were recruited, 18 male, age 69 ± 8 years, New York Heart Association class II-IV, QRS duration 173 ± 21 ms and left ventricular ejection fraction 26±8%. Handgrip strength was measured at baseline before, and 6 and 12 months, following cardiac resynchronization therapy. Response was assessed using quality of life questionnaire, 6-minute walk distance, left ventricular end-diastolic volume, and cardiopulmonary exercise testing at the same time points. Results Fourteen patients were identified as responders, demonstrating significant improvements in all four markers of response. There was no significant difference at baseline in left or right handgrip strength between responders and non-responders. Compared to baseline, handgrip strength significantly increased in responders during follow-up, left (34.4 ± 11.4 to 40.3 ± 11.3 kgf, P < 0.001) and right (35.7 ± 12.5 to 42.2 ± 11.5 kgf, P < 0.001) at 12 months. No such improvement was seen in non-responders. Conclusions This study demonstrates that positive response to cardiac resynchronization therapy is associated with significant gains in handgrip strength, suggesting that cardiac resynchronization therapy may indirectly lead to secondary gains in skeletal muscle function.
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Affiliation(s)
- David R Warriner
- Medical Physics Group, Department of Cardiovascular Science, The Medical School, University of Sheffield, Sheffield, S10 2TN, UK; Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, UK
| | - Patricia Lawford
- Medical Physics Group, Department of Cardiovascular Science, The Medical School, University of Sheffield, Sheffield, S10 2TN, UK
| | - Paul J Sheridan
- Department of Cardiology, Chesterfield Royal Hospital, Chesterfield, Derbyshire, S44 5BL, UK
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Warriner DR, Lawford P, Sheridan PJ. Measures of endothelial dysfunction predict response to cardiac resynchronisation therapy. Open Heart 2016; 3:e000391. [PMID: 27335654 PMCID: PMC4908901 DOI: 10.1136/openhrt-2015-000391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/09/2016] [Accepted: 02/23/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Cardiac resynchronisation therapy (CRT) improves morbidity and mortality in heart failure (HF). Impaired endothelial function, as measured by flow-mediated dilation (FMD) is associated with increased morbidity and mortality in HF and may help to differentiate responders from non-responders. METHODS 19 patients were recruited, comprising 94% men, mean age 69±8 years, New York Heart Association functional classes II-IV, QRSd 161±21 ms and mean left ventricular ejection fraction 26±8%. Markers of response and FMD were measured at baseline, 6 and 12 months following CRT. RESULTS 14 patients were responders to CRT. Responders had significant improvements in VO2 (12.6±1.7 to 14.7±1.5 mL/kg/min, p<0.05), quality of life score (44.4±22.9-24.1±21.3, p<0.01), left ventricular end diastolic volume (201.5±72.5 mL-121.3±72.0 mL, p<0.01) and 6-min walk distance (374.0±112.8 m at baseline to 418.1±105.3 m, p<0.05). Baseline FMD in responders was 2.9±1.9% and 7.4±3.73% in non-responders (p<0.05). CONCLUSIONS Response to CRT at 6 and 12 months is predicted by baseline FMD. This study confirms that FMD identifies responders to CRT, due to endothelium-dependent mechanisms alone.
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Affiliation(s)
- David R Warriner
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, UK; Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Patricia Lawford
- Medical Physics Group, Department of Cardiovascular Science , University of Sheffield , Sheffield , UK
| | - Paul J Sheridan
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, UK; Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Herold IHF, Saporito S, Mischi M, van Assen HC, Bouwman RA, de Lepper AGW, van den Bosch HCM, Korsten HHM, Houthuizen P. Pulmonary transit time measurement by contrast-enhanced ultrasound in left ventricular dyssynchrony. Echo Res Pract 2016; 3:35-43. [PMID: 27249553 PMCID: PMC4989099 DOI: 10.1530/erp-16-0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/16/2016] [Indexed: 11/08/2022] Open
Abstract
Background Pulmonary transit time (PTT) is an indirect measure of preload and left ventricular function, which can be estimated using the indicator dilution theory by contrast-enhanced ultrasound (CEUS). In this study, we first assessed the accuracy of PTT-CEUS by comparing it with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Secondly, we tested the hypothesis that PTT-CEUS correlates with the severity of heart failure, assessed by MRI and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Methods and results Twenty patients referred to our hospital for cardiac resynchronization therapy (CRT) were enrolled. DCE-MRI, CEUS, and NT-proBNP measurements were performed within an hour. Mean transit time (MTT) was obtained by estimating the time evolution of indicator concentration within regions of interest drawn in the right and left ventricles in video loops of DCE-MRI and CEUS. PTT was estimated as the difference of the left and right ventricular MTT. Normalized PTT (nPTT) was obtained by multiplication of PTT with the heart rate. Mean PTT-CEUS was 10.5±2.4s and PTT-DCE-MRI was 10.4±2.0s (P=0.88). The correlations of PTT and nPTT by CEUS and DCE-MRI were strong; r=0.75 (P=0.0001) and r=0.76 (P=0.0001), respectively. Bland–Altman analysis revealed a bias of 0.1s for PTT. nPTT-CEUS correlated moderately with left ventricle volumes. The correlations for PTT-CEUS and nPTT-CEUS were moderate to strong with NT-proBNP; r=0.54 (P=0.022) and r=0.68 (P=0.002), respectively. Conclusions (n)PTT-CEUS showed strong agreement with that by DCE-MRI. Given the good correlation with NT-proBNP level, (n)PTT-CEUS may provide a novel, clinically feasible measure to quantify the severity of heart failure. Clinical Trial Registry: NCT01735838
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Affiliation(s)
- Ingeborg H F Herold
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Salvatore Saporito
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Hans C van Assen
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Anouk G W de Lepper
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Hendrikus H M Korsten
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Eindhoven, the Netherlands Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
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Abstract
Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.
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