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Schäfer M, Miyamoto SD, Jaggers J, Everitt MD, von Alvensleben JC, Campbell DN, Mitchell MB, Stone ML. Non-invasive myocardial tissue deformation and discoordination indices predict cardiac allograft vasculopathy in pediatric heart transplantation patients. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1565-1574. [PMID: 38780709 DOI: 10.1007/s10554-024-03143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
There is an urgent need for non-invasive imaging-based biomarkers suitable for diagnostic surveillance of cardiac allograft vasculopathy (CAV) in pediatric heart transplant (PHT) patients. The purpose of this study was to comprehensively investigate left ventricular (LV) myocardial deformation in conjunction with electromechanical discoordination in PHT. PHT patients with and without CAV were evaluated for echocardiography derived global longitudinal strain (GLS) and electromechanical discoordination indices including systolic stretch fraction (SSF) and diastolic relaxation fraction (DRF). SSF was increased in CAV(+) patients at the time of CAV diagnosis (median CAV(+) 5.0 vs. median CAV(-) 0.0, P = 0.008) and in the echocardiogram preceding the CAV diagnosis (median CAV(+) 29.0 vs. median CAV(-) 0.0, P < 0.001). DRF was also increased in the echocardiogram that preceded CAV diagnosis in CAV(+) patients (0.31 ± 0.08 vs. 0.25 ± 0.05, P = 0.008). The final model using indices 6-12 months prior to CAV diagnosis included GLS, SSF, and DRF providing AUC of 0.94 with sensitivity 98.5%, specificity 80.0%, positive predictive value 85.0%, and negative predictive value 94.1%. Systolic and diastolic electro-mechanical discoordination indices are significantly worse in PHT patients experiencing CAV. Non-invasive imaging guided surveillance using echocardiographic myocardial deformation indices can be improved by adding SSF and DRF to standard GLS measurements.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.
- Heart Institute, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045-2560, USA.
| | - Shelley D Miyamoto
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - James Jaggers
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Melanie D Everitt
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Johannes C von Alvensleben
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - David N Campbell
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Max B Mitchell
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew L Stone
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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Sperlongano S, Benfari G, Ilardi F, Lisi M, Malagoli A, Mandoli GE, Pastore MC, Mele D, Cameli M, D'Andrea A. Role of speckle tracking echocardiography beyond current guidelines in cardiac resynchronization therapy. Int J Cardiol 2024; 402:131885. [PMID: 38382847 DOI: 10.1016/j.ijcard.2024.131885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/11/2024] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
Cardiac resynchronization therapy (CRT) is a device-based treatment applied to patients with a specific profile of heart failure. According to current guidelines, indication for CRT is given on the basis of QRS morphology and duration, and traditional transthoracic echocardiography is mainly used to estimate left ventricular (LV) ejection fraction. However, the identification of patients who may benefit from CRT remains challenging, since the application of the above-mentioned guidelines is still associated with a high rate of non-responders. The assessment of various aspects of LV mechanics (including contractile synchrony, coordination and propagation, and myocardial work) performed by conventional and novel ultrasound technologies, first of all speckle tracking echocardiography (STE), may provide additional, useful information for CRT patients' selection, in particular among non-LBBB patients, who generally respond less to CRT. A multiparametric approach, based on the combination of ECG criteria and echocardiographic indices of LV dyssynchrony/discoordination would be desirable to improve the prediction of CRT response.
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Affiliation(s)
- Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Matteo Lisi
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences, University of Padua, Padua, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonello D'Andrea
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy; Department of Cardiology, Umberto I Hospital, Nocera Inferiore, Italy
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Sonaglioni A, Nicolosi GL, Trevisan R, Lombardo M, Grasso E, Gensini GF, Ambrosio G. The influence of pectus excavatum on cardiac kinetics and function in otherwise healthy individuals: A systematic review. Int J Cardiol 2023; 381:135-144. [PMID: 37003372 DOI: 10.1016/j.ijcard.2023.03.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/28/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND A number of anterior chest wall deformities, most notably pectus excavatum (PE), may have a detrimental effect on cardiac motion and function. Interpretation of transthoracic echocardiography (TTE) and speckle-tracking echocardiography (STE) results may be hampered by the possible influence of PE on cardiac kinetics. METHODS A comprehensive search of all articles assessing cardiac function in PE individuals was carried out. Inclusion criteria were: 1) individuals aged >10 years; 2) studies providing objective assessment of chest deformity (Haller index). Studies that measured myocardial strain parameters in PE patients were also included. RESULTS The search (EMBASE and Medline) yielded a total of 392 studies, 36 (9.2%) of which removed as duplicates; a further 339 did not meet inclusion criteria. The full-texts of 17 studies were then analyzed. All studies concordantly reported impaired right ventricular volumes and function. With respect to left ventricle (LV), TTE studies uniformly demonstrated a significant impairment in conventional echoDoppler indices in PE individuals, whereas STE studies provided conflicting results. Importantly, LV functional alterations promptly reverted upon surgical correction of chest defect. In subjects with PE of mild-to-moderate severity, we observed that degree of anterior chest wall deformity, as noninvasively assessed by modified Haller index (MHI), was strongly associated with myocardial strain magnitude, in heterogenous cohorts of otherwise healthy PE individuals. CONCLUSIONS Clinicians should be aware that in PE individuals, TTE and STE results may not always be indicative of intrinsic myocardial dysfunction, but may be, at least in part, influenced by artifactual and/or external chest shape determinants.
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Affiliation(s)
| | | | | | | | - Enzo Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
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The role of cardiac magnetic resonance in identifying appropriate candidates for cardiac resynchronization therapy - a systematic review of the literature. Heart Fail Rev 2022; 27:2095-2118. [PMID: 36045189 DOI: 10.1007/s10741-022-10263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Abstract
Despite the strict indications for cardiac resynchronization therapy (CRT) implantation, a significant proportion of patients will fail to adequately respond to the treatment. This systematic review aims to present the existing evidence about the role of cardiac magnetic resonance (CMR) in identifying patients who are likely to respond better to the CRT. A systematic search in the MedLine database and Cochrane Library from their inception to August 2021 was performed, without any limitations, by two independent investigators. We considered eligible observational studies or randomized clinical trials (RCTs) that enrolled patients > 18 years old with heart failure (HF) of ischaemic or non-ischaemic aetiology and provided data about the association of baseline CMR variables with clinical or echocardiographic response to CRT for at least 3 months. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). Following our search strategy, 47 studies were finally included in our review. CMR appears to have an additive role in identifying the subgroup of patients who will respond better to CRT. Specifically, the presence and the extent of myocardial scar were associated with increased non-response rates, while those with no scar respond better. Furthermore, existing data show that scar location can be associated with CRT response rates. CMR-derived markers of mechanical desynchrony can also be used as predictors of CRT response. CMR data can be used to optimize the position of the left ventricular lead during the CRT implantation procedure. Specifically, positioning the left ventricular lead in a branch of the coronary sinus that feeds an area with transmural scar was associated with poorer response to CRT. CMR can be used as a non-invasive optimization tool to identify patients who are more likely to achieve better clinical and echocardiographic response following CRT implantation.
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Schäfer M, Frank BS, Ivy DD, Mitchell MB, Collins KK, Jone PN, von Alvensleben JC. Repolarization Dispersion Is Associated With Diastolic Electromechanical Discoordination in Children With Pulmonary Arterial Hypertension. J Am Heart Assoc 2022; 11:e024787. [PMID: 35229614 PMCID: PMC9075289 DOI: 10.1161/jaha.121.024787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Electromechanical dyssynchrony is a well described comorbidity in pulmonary arterial hypertension (PAH). ECG‐derived measurements reflective of diastolic dysfunction and electromechanical imaging markers are yet to be investigated. In this study we investigated the ECG‐ derived marker of repolarization dispersion, interval between the peak and end of T wave (TpTe), in pediatric patients with PAH and left ventricular (LV) diastolic dysfunction. Methods and Results We measured TpTe from a standard 12‐lead ECG and in 30 children with PAH and matched control subjects. All participants underwent same‐day echocardiography and myocardial strain analysis to calculate the diastolic electromechanical discoordination marker diastolic relaxation fraction. When compared with control subjects, patients with PAH had increased TpTe (93±15 versus 81±12 ms, P=0.001) and elevated diastolic relaxation fraction (0.33±0.10 versus 0.27±0.03, P=0.001). Patients with PAH with LV diastolic dysfunction had significantly increased TpTe when compared with patients with PAH without diastolic dysfunction (P=0.012) and when compared with control group (P<0.001). Similarly, patients with PAH with LV diastolic dysfunction had increased diastolic relaxation fraction when compared with PAH patients without diastolic dysfunction (P=0.007) and when compared with control group (P<0.001). A 10‐ms increase in TpTe was significantly associated with 0.023 increase in diastolic relaxation fraction (P=0.008) adjusting for body surface area, heart rate, right ventricular volumes, and function. Conclusions Prolonged myocardial repolarization and abnormal LV diastolic electromechanical discoordination exist in parallel in children with PAH and are associated with worse LV diastolic function and functional class.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiology Heart InstituteChildren's Hospital ColoradoUniversity of Colorado Denver Denver CO
| | - Benjamin S Frank
- Division of Cardiology Heart InstituteChildren's Hospital ColoradoUniversity of Colorado Denver Denver CO
| | - D Dunbar Ivy
- Division of Cardiology Heart InstituteChildren's Hospital ColoradoUniversity of Colorado Denver Denver CO
| | - Max B Mitchell
- Section of Congenital Heart Surgery Heart InstituteChildren's Hospital ColoradoUniversity of Colorado DenverAnschutz Medical Campus Aurora CO
| | - Kathryn K Collins
- Division of Cardiology Heart InstituteChildren's Hospital ColoradoUniversity of Colorado Denver Denver CO
| | - Pei-Ni Jone
- Division of Cardiology Heart InstituteChildren's Hospital ColoradoUniversity of Colorado Denver Denver CO
| | - Johannes C von Alvensleben
- Division of Cardiology Heart InstituteChildren's Hospital ColoradoUniversity of Colorado Denver Denver CO
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Zweerink A, Friedman DJ, Klem I, van de Ven PM, Vink C, Biesbroek PS, Hansen SM, Kim RJ, van Rossum AC, Atwater BD, Allaart CP, Nijveldt R. Segment Length in Cine Strain Analysis Predicts Cardiac Resynchronization Therapy Outcome Beyond Current Guidelines. Circ Cardiovasc Imaging 2021; 14:e012350. [PMID: 34287001 DOI: 10.1161/circimaging.120.012350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with a class I recommendation for cardiac resynchronization therapy (CRT) are likely to benefit, but the effect of CRT in class II patients is more heterogeneous and additional selection parameters are needed in this group. The recently validated segment length in cine strain analysis of the septum (SLICE-ESSsep) measurement on cardiac magnetic resonance cine imaging predicts left ventricular functional recovery after CRT but its prognostic value is unknown. This study sought to evaluate the prognostic value of SLICE-ESSsep for clinical outcome after CRT. METHODS Two hundred eighteen patients with a left bundle branch block or intraventricular conduction delay and a class I or class II indication for CRT who underwent preimplantation cardiovascular magnetic resonance examination were enrolled. SLICE-ESSsep was manually measured on standard cardiovascular magnetic resonance cine imaging. The primary combined end point was all-cause mortality, left ventricular assist device, or heart transplantation. Secondary end points were (1) appropriate implantable cardioverter defibrillator therapy and (2) heart failure hospitalization. RESULTS Two-thirds (65%) of patients had a positive SLICE-ESSsep ≥0.9% (ie, systolic septal stretching). During a median follow-up of 3.8 years, 66 (30%) patients reached the primary end point. Patients with positive SLICE-ESSsep were at lower risk to reach the primary end point (hazard ratio 0.36; P<0.001) and heart failure hospitalization (hazard ratio 0.41; P=0.019), but not for implantable cardioverter defibrillator therapy (hazard ratio, 0.66; P=0.272). Clinical outcome of class II patients with a positive ESSsep was similar to those of class I patients (hazard ratio, 1.38 [95% CI, 0.66-2.88]; P=0.396). CONCLUSIONS Strain assessment of the septum (SLICE-ESSsep) provides a prognostic measure for clinical outcome after CRT. Detection of a positive SLICE-ESSsep in patients with a class II indication predicts improved CRT outcome similar to those with a class I indication whereas SLICE-ESSsep negative patients have poor prognosis after CRT implantation.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS) (A.Z., C.V., P.S.B., A.C.v.R., C.P.A., R.N.), Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - Daniel J Friedman
- Section of Cardiac Electrophysiology, Yale School of Medicine, New Haven, CT (D.J.F., R.J.K.)
| | - Igor Klem
- Division of Cardiology, Duke University Medical Center, Durham, NC (I.K.)
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics (P.M.v.d.V.), Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - Caitlin Vink
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS) (A.Z., C.V., P.S.B., A.C.v.R., C.P.A., R.N.), Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - P Stefan Biesbroek
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS) (A.Z., C.V., P.S.B., A.C.v.R., C.P.A., R.N.), Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - Steen M Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark (S.M.H.)
| | - Raymond J Kim
- Section of Cardiac Electrophysiology, Yale School of Medicine, New Haven, CT (D.J.F., R.J.K.)
| | - Albert C van Rossum
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS) (A.Z., C.V., P.S.B., A.C.v.R., C.P.A., R.N.), Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | | | - Cornelis P Allaart
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS) (A.Z., C.V., P.S.B., A.C.v.R., C.P.A., R.N.), Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS) (A.Z., C.V., P.S.B., A.C.v.R., C.P.A., R.N.), Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (R.N.)
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Mele D, Trevisan F, Fiorencis A, Smarrazzo V, Bertini M, Ferrari R. Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis. Curr Heart Fail Rep 2021; 17:384-396. [PMID: 32979151 DOI: 10.1007/s11897-020-00484-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to summarily explain what LV synchrony, coordination, myocardial work, and flow dynamics are, trying to clarify their advantages and limitations in the treatment of heart failure patients undergoing or with implanted cardiac resynchronization therapy (CRT). RECENT FINDINGS CRT is an established treatment for patients with heart failure and left ventricular systolic dysfunction. In the current guidelines, CRT implant indications rely only on electrical dyssynchrony, but in the last years, many aspects of cardiac mechanics (including contractile synchrony, coordination, propagation, and myocardial work) and flow dynamics have been studied using echocardiographic techniques to better characterize patients undergoing or with implanted CRT. However, the concepts, limits, and potential applications of all these echocardiographic evaluations are unclear to most clinicians. The use of left ventricular dyssynchrony and discoordination indices may help to identify those significant mechanical alterations whose correction may increase the probability of a favorable CRT response. Assessment of myocardial work and intracardiac flow dynamics may overcome some limitations of the conventional evaluation of cardiac mechanics but more investigations are needed before extensive clinical application.
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Affiliation(s)
- Donato Mele
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy.
| | - Filippo Trevisan
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Andrea Fiorencis
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Vittorio Smarrazzo
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Matteo Bertini
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Roberto Ferrari
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
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Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application. Diagnostics (Basel) 2021; 11:diagnostics11050892. [PMID: 34067703 PMCID: PMC8156791 DOI: 10.3390/diagnostics11050892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. However, its symptoms and signs are not specific or can be absent. In this context, transthoracic echocardiography plays a key role in diagnosing the various forms of HF, guiding therapeutic decision making and monitoring response to therapy. Over the last few decades, new ultrasound modalities have been introduced in the field of echocardiography, aiming at better understanding the morpho-functional abnormalities occurring in cardiovascular diseases. However, they are still struggling to enter daily and routine use. In our review article, we turn the spotlight on some of the newest ultrasound technologies; in particular, analysis of myocardial deformation by speckle tracking echocardiography, and intracardiac flow dynamics by color Doppler flow mapping, highlighting their promising applications to HF diagnosis and management. We also focus on the importance of these imaging modalities in the selection of responses to cardiac resynchronization therapy.
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Wouters PC, Leenders GE, Cramer MJ, Meine M, Prinzen FW, Doevendans PA, De Boeck BWL. Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy. Int J Cardiovasc Imaging 2021; 37:1903-1911. [PMID: 33547623 PMCID: PMC8255256 DOI: 10.1007/s10554-021-02174-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. METHODS In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. RESULTS CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. CONCLUSION Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.
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Affiliation(s)
- Philippe C Wouters
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Geert E Leenders
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Maarten J Cramer
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Mathias Meine
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Frits W Prinzen
- Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | | | - Bart W L De Boeck
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.,Luzerner Kantonsspital, 6000, Luzern, Switzerland
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Zweerink A, Nijveldt R, Braams NJ, Maass AH, Vernooy K, de Lange FJ, Meine M, Geelhoed B, Rienstra M, van Gelder IC, Vos MA, van Rossum AC, Allaart CP. Segment length in cine (SLICE) strain analysis: a practical approach to estimate potential benefit from cardiac resynchronization therapy. J Cardiovasc Magn Reson 2021; 23:4. [PMID: 33423681 PMCID: PMC7798189 DOI: 10.1186/s12968-020-00701-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 08/24/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Segment length in cine (SLICE) strain analysis on standard cardiovascular magnetic resonance (CMR) cine images was recently validated against gold standard myocardial tagging. The present study aims to explore predictive value of SLICE for cardiac resynchronization therapy (CRT) response. METHODS AND RESULTS Fifty-seven patients with heart failure and left bundle branch block (LBBB) were prospectively enrolled in this multi-center study and underwent CMR examination before CRT implantation. Circumferential strains of the septal and lateral wall were measured by SLICE on short-axis cine images. In addition, timing and strain pattern parameters were assessed. After twelve months, CRT response was quantified by the echocardiographic change in left ventricular (LV) end-systolic volume (LVESV). In contrast to timing parameters, strain pattern parameters being systolic rebound stretch of the septum (SRSsep), systolic stretch index (SSIsep-lat), and internal stretch factor (ISFsep-lat) all correlated significantly with LVESV change (R - 0.56; R - 0.53; and R - 0.58, respectively). Of all strain parameters, end-systolic septal strain (ESSsep) showed strongest correlation with LVESV change (R - 0.63). Multivariable analysis showed ESSsep to be independently related to LVESV change together with age and QRSAREA. CONCLUSION The practicable SLICE strain technique may help the clinician to estimate potential benefit from CRT by analyzing standard CMR cine images without the need for commercial software. Of all strain parameters, end-systolic septal strain (ESSsep) demonstrates the strongest correlation with reverse remodeling after CRT. This parameter may be of special interest in patients with non-strict LBBB morphology for whom CRT benefit is doubted.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers (AUMC), Location VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers (AUMC), Location VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Natalia J. Braams
- Department of Cardiology, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers (AUMC), Location VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Alexander H. Maass
- Department of Cardiology, Thoraxcentre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frederik J. de Lange
- Department of Cardiology, Amsterdam University Medical Centers (AUMC), Location Academic Medical Center, Amsterdam, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bastiaan Geelhoed
- Department of Cardiology, Thoraxcentre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thoraxcentre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Isabelle C. van Gelder
- Department of Cardiology, Thoraxcentre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marc A. Vos
- Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers (AUMC), Location VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers (AUMC), Location VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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11
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Isotani A, Yoneda K, Iwamura T, Watanabe M, Okada JI, Washio T, Sugiura S, Hisada T, Ando K. Patient-specific heart simulation can identify non-responders to cardiac resynchronization therapy. Heart Vessels 2020; 35:1135-1147. [PMID: 32166443 PMCID: PMC7332486 DOI: 10.1007/s00380-020-01577-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/28/2020] [Indexed: 11/30/2022]
Abstract
To identify non-responders to cardiac resynchronization therapy (CRT), various biomarkers have been proposed, but these attempts have not been successful to date. We tested the clinical applicability of computer simulation of CRT for the identification of non-responders. We used the multi-scale heart simulator “UT-Heart,” which can reproduce the electrophysiology and mechanics of the heart based on a molecular model of the excitation–contraction mechanism. Patient-specific heart models were created for eight heart failure patients who were treated with CRT, based on the clinical data recorded before treatment. Using these heart models, bi-ventricular pacing simulations were performed at multiple pacing sites adopted in clinical practice. Improvement in pumping function measured by the relative change of maximum positive derivative of left ventricular pressure (%ΔdP/dtmax) was compared with the clinical outcome. The operators of the simulation were blinded to the clinical outcome. In six patients, the relative reduction in end-systolic volume exceeded 15% in the follow-up echocardiogram at 3 months (responders) and the remaining two patients were judged as non-responders. The simulated %ΔdP/dtmax at the best lead position could identify responders and non-responders successfully. With further refinement of the model, patient-specific simulation could be a useful tool for identifying non-responders to CRT.
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Affiliation(s)
- Akihiro Isotani
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Asano 3-2-1, Kokurakita-ku, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Kazunori Yoneda
- Healthcare System Unit, Fujitsu Ltd, Ota-ku, Kamata, 144-8588, Japan
| | - Takashi Iwamura
- Healthcare System Unit, Fujitsu Ltd, Ota-ku, Kamata, 144-8588, Japan
| | - Masahiro Watanabe
- Healthcare System Unit, Fujitsu Ltd, Ota-ku, Kamata, 144-8588, Japan
| | - Jun-Ichi Okada
- Future Center Initiative, The University of Tokyo, Wakashiba 178-4-4, Kashiwa, Chiba, 277-0871, Japan
- UT-Heart Inc. Nozawa, 3-25-8, Setagaya, Tokyo, 154-0003, Japan
| | - Takumi Washio
- Future Center Initiative, The University of Tokyo, Wakashiba 178-4-4, Kashiwa, Chiba, 277-0871, Japan
- UT-Heart Inc. Nozawa, 3-25-8, Setagaya, Tokyo, 154-0003, Japan
| | - Seiryo Sugiura
- UT-Heart Inc. Nozawa, 3-25-8, Setagaya, Tokyo, 154-0003, Japan.
- Future Center #304, Wakashiba 178-4-4, Kashiwa, Chiba, 277-0871, Japan.
| | - Toshiaki Hisada
- UT-Heart Inc. Nozawa, 3-25-8, Setagaya, Tokyo, 154-0003, Japan
| | - Kenji Ando
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Asano 3-2-1, Kokurakita-ku, Kitakyushu, Fukuoka, 802-8555, Japan
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12
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Schäfer M, Bjornstad P, Frank BS, Baumgartner A, Truong U, Enge D, von Alvensleben JC, Mitchell MB, Ivy DD, Barker AJ, Reusch JEB, Nadeau KJ. Frequency of Reduced Left Ventricular Contractile Efficiency and Discoordinated Myocardial Relaxation in Patients Aged 16 to 21 Years With Type 1 Diabetes Mellitus (from the Emerald Study). Am J Cardiol 2020; 128:45-53. [PMID: 32650923 PMCID: PMC7585937 DOI: 10.1016/j.amjcard.2020.04.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
Early-onset cardiomyopathy is a major concern for people with type 1 diabetes mellitus (DM). Studies examining myocardial deformation indices early in the disease process in people with have provided conflicting results. Accordingly, the objective was to examine left ventricular (LV) function in adolescents with type 1 DM using novel measures of cardiomyopathy, termed ventricular discoordination indices, including systolic stretch fraction (SSF), and our newly developed diastolic relaxation fraction (DRF). Adolescents with DM (n = 16) and healthy controls (n = 20) underwent cardiac MRI (CMR) tissue tracking analysis for standard volumetric and functional analysis. Segment-specific circumferential strain and strain rate indices were evaluated to calculate standard mechanical dyssynchrony and discoordination. SSF and DRF were calculated from strain rate data. There were no global or regional group differences between participants with DM and controls in standard LV strain mechanics. However, youth with DM had lower diastolic strain rate around the inferior septal and free wall region (all p <0.05) as well as higher SSF (p = 0.03) and DRF (p <0.001) compared with controls. None of the CMR indices correlated with HbA1c or diabetes duration. In conclusion, our results suggest that adolescents with DM have LV systolic and diastolic discoordination, providing early evidence of cardiomyopathy despite their young age. The presence of discoordination in the setting of normal LV size and function suggests that the proposed novel discoordination indices could serve as a more sensitive marker of cardiomyopathy than previously employed mechanical deformation indices.
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Affiliation(s)
- Michal Schäfer
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Petter Bjornstad
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Benjamin S Frank
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Amy Baumgartner
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Nephrology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Uyen Truong
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Enge
- Division of Endocrinology, Rocky Mountain Regional VAMC, Colorado; Department of Bioengineering, University of Colorado Denver | Anschutz Medical Campus, Denver, Colorado
| | - Johannes C von Alvensleben
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Max B Mitchell
- Division of Congenital Cardiac Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - D Dunbar Ivy
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Alex J Barker
- Department of Bioengineering, University of Colorado Denver | Anschutz Medical Campus, Denver, Colorado; Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jane E B Reusch
- Division of Endocrinology, Rocky Mountain Regional VAMC, Colorado
| | - Kristen J Nadeau
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Nephrology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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13
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Frank BS, Schäfer M, Douwes JM, Ivy DD, Abman SH, Davidson JA, Burzlaff S, Mitchell MB, Morgan GJ, Browne LP, Barker AJ, Truong U, von Alvensleben JC. Novel measures of left ventricular electromechanical discoordination predict clinical outcomes in children with pulmonary arterial hypertension. Am J Physiol Heart Circ Physiol 2020; 318:H401-H412. [PMID: 31858817 PMCID: PMC7052618 DOI: 10.1152/ajpheart.00355.2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 01/16/2023]
Abstract
Adverse ventricle-ventricle interaction and resultant left ventricular (LV) dysfunction are a recognized pathophysiological component of disease progression in pulmonary arterial hypertension (PAH) and can be associated with electrical and mechanical dyssynchrony. The purpose of this study was to investigate the clinical and mechanistic implications of LV electromechanical dyssynchrony in children with PAH by using novel systolic stretch and diastolic relaxation discoordination indexes derived noninvasively from cardiac MRI (CMR). In children with PAH referred for CMR (n = 64) and healthy controls (n = 20), we calculated two novel markers of ventricular discoordination, systolic stretch fraction (SSF) and diastolic relaxation fraction (DRF). SSF and DRF were evaluated with respect to 1) electrical dyssynchrony, 2) functional status, and 3) composite clinical outcomes. SSF was increased in patients with PAH compared with controls (P = 0.004). There was no difference in DRF between PAH and control groups. There were no differences between groups in standard mechanical dyssynchrony and LV global circumferential strain. Increased SSF was associated with greater electrical dyssynchrony (QRS duration) as well as worse WHO functional class. SSF, DRF, mechanical dyssynchrony, and right ventricular (RV) volumes were prognostic for worse clinical outcomes. LV dyssynchrony indexes are altered in pediatric patients with PAH compared with controls in proportion with greater degrees of RV dilation. Patients with PAH with greater dyssynchrony have worse clinical outcomes. RV-induced increased LV electromechanical dyssynchrony therefore may be an important link in the causal pathway from PAH to clinically significant LV dysfunction. Since dyssynchrony could precede overt LV dysfunction, addition of ventricular synchrony analysis to CMR postprocessing protocols may be of clinical benefit.NEW & NOTEWORTHY We demonstrate that left ventricular discoordination indexes are altered in pediatric patients with pulmonary arterial hypertension compared with controls and pediatric patients with pulmonary arterial hypertension with greater dyssynchrony have worse clinical outcomes. Furthermore, there is evidence for the mechanism of right ventricular-induced left ventricular discoordination to include a combination of delayed early systolic electromechanical activation, late-systolic septal shift, and prolonged, postsystolic septal thickening.
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Affiliation(s)
- Benjamin S Frank
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Michal Schäfer
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Johannes M Douwes
- Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - D Dunbar Ivy
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Steven H Abman
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Jesse A Davidson
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Sandra Burzlaff
- Ludwig-Maxmilian Munich University, Faculty of Medicine, Munich, Germany
| | - Max B Mitchell
- Section of Congenital Heart Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Gareth J Morgan
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Lorna P Browne
- Department of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Alex J Barker
- Department of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Uyen Truong
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
| | - Johannes C von Alvensleben
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado
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14
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Increased systolic vorticity in the left ventricular outflow tract is associated with abnormal aortic flow formations in Tetralogy of Fallot. Int J Cardiovasc Imaging 2020; 36:691-700. [DOI: 10.1007/s10554-019-01764-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/28/2019] [Indexed: 01/25/2023]
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15
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Fixsen LS, de Lepper AGW, Strik M, van Middendorp LB, Prinzen FW, van de Vosse FN, Houthuizen P, Lopata RGP. Echocardiographic Assessment of Left Bundle Branch-Related Strain Dyssynchrony: A Comparison With Tagged MRI. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2063-2074. [PMID: 31060858 DOI: 10.1016/j.ultrasmedbio.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
Recent studies have shown the efficacy of myocardial strain estimated using speckle tracking echocardiography (STE) in predicting response to cardiac resynchronisation therapy. This study focuses on circumferential strain patterns, comparing STE-acquired strains to tagged-magnetic resonance imaging (MRI-T). Second, the effect of regularisation was examined. Two-dimensional parasternal ultrasound (US) and MRI-T data were acquired in the left ventricular short-axis view of canines before (n = 8) and after (n = 9) left bunch branch block (LBBB) induction. US-based strain analysis was performed on Digital Imaging and Communications in Medicine data at the mid-level using three overall methods ("Commercial software," "Basic block-matching," "regularised block-matching"). Moreover, three regularisation approaches were implemented and compared. MRI-T analysis was performed using SinMod. Normalised regional circumferential strain curves, based on standard six or septal/lateral segments, were analysed and cross-correlated with MRI-T data. Systolic strain (SS) and septal rebound stretch (SRS) were calculated and compared. Overall agreement of normalised circumferential strain was good between all methods on a global and regional level. All STE methods showed a bias (≥4% strain) toward higher SS estimates. Pre-LBBB, septal and lateral segment correlation was excellent between the Basic (mean ρ = 0.96) and regularised (mean ρ = 0.97) methods and MRI-T. The Commercial method showed a significant discrepancy between the two walls (septal ρ = 0.94, lateral ρ = 0.68). Correlation with MRI-T reduced between pre- and post-LBBB (Commercial ρ = 0.79, Basic ρ = 0.82, mean regularised ρ = 0.86). Septal strain patterns and SRS varied with the STE software and type of regularisation, with all STE methods estimating non-zero SRS values pre-LBBB. Absolute values showed moderate agreement, with a bias for higher strain from STE. SRS varied with the type of software and extra regularisation applied. Open efforts are needed to understand the underlying causes of differences between STE methods before standardisation can be achieved. This is particularly important given the apparent clinical value of strain-based parameters such as SRS.
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Affiliation(s)
- Louis S Fixsen
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | | | - Marc Strik
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Lars B van Middendorp
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Frans N van de Vosse
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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16
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Friedberg MK. Another Step in the Right Direction: Resynchronizing the Dyssynchronous Right Ventricle Improves Its Efficiency and Function. Circ Cardiovasc Imaging 2019; 10:CIRCIMAGING.117.006905. [PMID: 28877887 DOI: 10.1161/circimaging.117.006905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark K Friedberg
- From the Labatt Family Heart Centre, Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics, University of Toronto, Ontario, Canada.
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17
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Cardiac resynchronisation therapy optimisation of interventricular delay by the systolic dyssynchrony index: A comparative, randomised, 12-month follow-up study. Hellenic J Cardiol 2019; 60:16-25. [DOI: 10.1016/j.hjc.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/29/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022] Open
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18
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Zweerink A, van Everdingen WM, Nijveldt R, Salden OAE, Meine M, Maass AH, Vernooy K, de Lange FJ, Vos MA, Croisille P, Clarysse P, Geelhoed B, Rienstra M, van Gelder IC, van Rossum AC, Cramer MJ, Allaart CP. Strain imaging to predict response to cardiac resynchronization therapy: a systematic comparison of strain parameters using multiple imaging techniques. ESC Heart Fail 2018; 5:1130-1140. [PMID: 30051598 PMCID: PMC6300826 DOI: 10.1002/ehf2.12335] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/15/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Various strain parameters and multiple imaging techniques are presently available including cardiovascular magnetic resonance (CMR) tagging (CMR‐TAG), CMR feature tracking (CMR‐FT), and speckle tracking echocardiography (STE). This study aims to compare predictive performance of different strain parameters and evaluate results per imaging technique to predict cardiac resynchronization therapy (CRT) response. Methods and results Twenty‐seven patients were prospectively enrolled and underwent CMR and echocardiographic examination before CRT implantation. Strain analysis was performed in circumferential (CMR‐TAG, CMR‐FT, and STE‐circ) and longitudinal (STE‐long) orientations. Regional strain values, parameters of dyssynchrony, and discoordination were calculated. After 12 months, CRT response was measured by the echocardiographic change in left ventricular (LV) end‐systolic volume (LVESV). Twenty‐six patients completed follow‐up; mean LVESV change was −29 ± 27% with 17 (65%) patients showing ≥15% LVESV reduction. Measures of dyssynchrony (SD‐TTPLV) and discoordination (ISFLV) were strongly related to CRT response when using CMR‐TAG (R2 0.61 and R2 0.57, respectively), but showed poor correlations for CMR‐FT and STE (all R2 ≤ 0.32). In contrast, the end‐systolic septal strain (ESSsep) parameter showed a consistent high correlation with LVESV change for all techniques (CMR‐TAG R2 0.60; CMR‐FT R2 0.50; STE‐circ R2 0.43; and STE‐long R2 0.43). After adjustment for QRS duration and QRS morphology, ESSsep remained an independent predictor of response per technique. Conclusions End‐systolic septal strain was the only parameter with a consistent good relation to reverse remodelling after CRT, irrespective of assessment technique. In clinical practice, this measure can be obtained by any available strain imaging technique and provides predictive value on top of current guideline criteria.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Odette A E Salden
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederik J de Lange
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - Pierre Croisille
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Patrick Clarysse
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Bastiaan Geelhoed
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
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19
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Donal E, Delgado V, Magne J, Bucciarelli-Ducci C, Leclercq C, Cosyns B, Sitges M, Edvardsen T, Sade E, Stankovic I, Agricola E, Galderisi M, Lancellotti P, Hernandez A, Plein S, Muraru D, Schwammenthal E, Hindricks G, Popescu BA, Habib G. Rational and design of EuroCRT: an international observational study on multi-modality imaging and cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2018; 18:1120-1127. [PMID: 28329299 DOI: 10.1093/ehjci/jex021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 01/06/2023] Open
Abstract
Aims Assessment of left ventricular (LV) volumes and ejection fraction (LVEF) with cardiac imaging is important in the selection of patients for cardiac resynchronization therapy (CRT). Several observational studies have explored the role of imaging-derived LV dyssynchrony parameters to predict the response to CRT, but have yielded inconsistent results, precluding the inclusion of imaging-derived LV dyssynchrony parameters in current guidelines for selection of patients for CRT. Methods The EuroCRT is a large European multicentre prospective observational study led by the European Association of Cardiovascular Imaging. We aim to explore if combing the value of cardiac magnetic resonance (CMR) and echocardiography could be beneficial for selecting heart failure patients for CRT in terms of improvement in long-term survival, clinical symptoms, LV function, and volumes. Speckle tracking echocardiography will be used to assess LV dyssynchrony and wasted cardiac work whereas myocardial scar will be assessed with late gadolinium contrast enhanced CMR. All data will be measured in core laboratories. The study will be conducted in European centres with known expertise in both CRT and multimodality cardiac imaging.
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Affiliation(s)
- Erwan Donal
- Cardiology, Rennes University Hospital, INSERM 1414 Clinical Investigation Center, Innovative Technology, 2 Rue Henri Le Guilloux, CHU Pontchaillou, Rennes F-35000, France.,LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Cardiologie, Limoges, France.,INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Biomedical Research Unity, University of Bristol, Bristol, UK
| | - Christophe Leclercq
- Cardiology, Rennes University Hospital, INSERM 1414 Clinical Investigation Center, Innovative Technology, 2 Rue Henri Le Guilloux, CHU Pontchaillou, Rennes F-35000, France.,LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France
| | | | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | | | - Ivan Stankovic
- Department of Cardiology, University Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Eustachio Agricola
- Cardiothoracic Department, San Raffaele University Hospital, IRCCS, 20132 Milan, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomeducal Sciences, Federico II University Hospital, Naples, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC), Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds, Clarendon Way, Leeds, UK
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua 35128, Italy
| | | | - Gerhard Hindricks
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Gilbert Habib
- LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France.,Department of Cardiology, Aix-Marseille Université, 13284 Marseille, France
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20
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Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
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21
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Mele D, Luisi GA, Malagù M, Laterza A, Ferrari R, Bertini M. Echocardiographic evaluation of cardiac dyssynchrony: Does it still matter? Echocardiography 2018; 35:707-715. [PMID: 29719067 DOI: 10.1111/echo.13902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. For many years, cardiac mechanical dyssynchrony assessed by echocardiography has been considered as a key evaluation to characterize CRT candidates and predict CRT response. In current guidelines, however, CRT implant indications rely only on electrical dyssynchrony. The aim of this article was to clarify whether and how the evaluation of cardiac mechanical dyssynchrony should be performed today by echocardiography.
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Affiliation(s)
- Donato Mele
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
| | | | - Michele Malagù
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
| | - Anna Laterza
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Matteo Bertini
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
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22
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Saporito S, Houthuizen P, Aben JPMM, Westenberg JJM, van Den Bosch HCM, van Assen HC, Mischi M. Endocardial center motion for quantification of left ventricular discoordination in heart failure using cine MRI. Physiol Meas 2018; 39:025009. [PMID: 29369050 DOI: 10.1088/1361-6579/aaaaa0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare a novel cardiovascular magnetic resonance technique for the assessment of left ventricular (LV) mechanical discoordination by characterizing the endocardial center motion (ECM) in short-axis cine MRI in healthy volunteers and heart failure patients with left bundle branch block (HF-LBBB). APPROACH To evaluate ECM analysis as mechanical discoordination measure, we retrospectively compared spatial and temporal features of the ECM between a group of healthy volunteers (n = 14) and conduction defect patients (HF-LBBB, n = 31). We tracked the center of the endocardial borders on short-axis view MRI cine loops during the cardiac cycle. From the ECM trajectory we calculated the overall traveled distance, the enclosed area, the eccentricity of the trajectory, and the maximum traveled distance. The ECM can be visualized in spatial coordinates as well as by its temporal behavior. We evaluated the classification performance of these measures for LBBB detection. We also quantified the coherence of the ECM on the longitudinal direction by considering the variability of the ECM measures between different short-axis slices. MAIN RESULTS Patients with LBBB showed significantly higher traveled distance (p < 0.0001), enclosed area (p < 0.002), eccentricity (p < 0.02), and peak displacement (p < 0.02) of the endocardial center. Patients with positive late gadolinium enhancement showed a higher variability of ECM measures across different slices (p < 0.05). SIGNIFICANCE ECM analysis is feasible and it allows the assessment of left ventricular mechanical discoordination. Differences in ECM measures permit one to distinguish between LBBB and healthy volunteers.
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Affiliation(s)
- Salvatore Saporito
- Department of Electrical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, Netherlands
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23
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van Everdingen WM, Zweerink A, Nijveldt R, Salden OAE, Meine M, Maass AH, Vernooy K, De Lange FJ, van Rossum AC, Croisille P, Clarysse P, Geelhoed B, Rienstra M, Van Gelder IC, Vos MA, Allaart CP, Cramer MJ. Comparison of strain imaging techniques in CRT candidates: CMR tagging, CMR feature tracking and speckle tracking echocardiography. Int J Cardiovasc Imaging 2017; 34:443-456. [PMID: 29043465 PMCID: PMC5847211 DOI: 10.1007/s10554-017-1253-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/29/2017] [Indexed: 01/22/2023]
Abstract
Parameters using myocardial strain analysis may predict response to cardiac resynchronization therapy (CRT). As the agreement between currently available strain imaging modalities is unknown, three different modalities were compared. Twenty-seven CRT-candidates, prospectively included in the MARC study, underwent cardiac magnetic resonance (CMR) imaging and echocardiographic examination. Left ventricular (LV) circumferential strain was analysed with CMR tagging (CMR-TAG), CMR feature tracking (CMR-FT), and speckle tracking echocardiography (STE). Basic strain values and parameters of dyssynchrony and discoordination obtained with CMR-FT and STE were compared to CMR-TAG. Agreement of CMR-FT and CMR-TAG was overall fair, while agreement between STE and CMR-TAG was often poor. For both comparisons, agreement on discoordination parameters was highest, followed by dyssynchrony and basic strain parameters. For discoordination parameters, agreement on systolic stretch index was highest, with fair intra-class correlation coefficients (ICC) (CMR-FT: 0.58, STE: 0.55). ICC of septal systolic rebound stretch (SRSsept) was poor (CMR-FT: 0.41, STE: 0.30). Internal stretch factor of septal and lateral wall (ISFsep-lat) showed fair ICC values (CMR-FT: 0.53, STE: 0.46), while the ICC of the total LV (ISFLV) was fair for CMR-FT (0.55) and poor for STE (ICC: 0.32). The CURE index had a fair ICC for both comparisons (CMR-FT: 0.49, STE 0.41). Although comparison of STE to CMR-TAG was limited by methodological differences, agreement between CMR-FT and CMR-TAG was overall higher compared to STE and CMR-TAG. CMR-FT is a potential clinical alternative for CMR-TAG and STE, especially in the detection of discoordination in CRT-candidates.
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Affiliation(s)
| | - Alwin Zweerink
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands
| | - Odette A. E. Salden
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alexander H. Maass
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Albert C. van Rossum
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands
| | - Pierre Croisille
- Université Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, 42023 Saint-Etienne, France
| | - Patrick Clarysse
- Université Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, 42023 Saint-Etienne, France
| | - Bastiaan Geelhoed
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Isabelle C. Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marc A. Vos
- Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands
| | - Maarten J. Cramer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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24
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Janoušek J, Kovanda J, Ložek M, Tomek V, Vojtovič P, Gebauer R, Kubuš P, Krejčíř M, Lumens J, Delhaas T, Prinzen F. Pulmonary Right Ventricular Resynchronization in Congenital Heart Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006424. [DOI: 10.1161/circimaging.117.006424] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 08/22/2017] [Indexed: 02/04/2023]
Abstract
Background—
Electromechanical discoordination may contribute to long-term pulmonary right ventricular (RV) dysfunction in patients after surgery for congenital heart disease. We sought to evaluate changes in RV function after temporary RV cardiac resynchronization therapy.
Methods and Results—
Twenty-five patients aged median 12.0 years after repair of tetralogy of Fallot and similar lesions were studied echocardiographically (n=23) and by cardiac catheterization (n=5) after primary repair (n=4) or after surgical RV revalvulation for significant pulmonary regurgitation (n=21). Temporary RV cardiac resynchronization therapy was applied in the presence of complete right bundle branch block by atrial-synchronized RV free wall pacing in complete fusion with spontaneous ventricular depolarization using temporary electrodes. The q-RV interval at the RV free wall pacing site (mean 77.2% of baseline QRS duration) confirmed pacing from a late activated RV area. RV cardiac resynchronization therapy carried significant decrease in QRS duration (
P
<0.001) along with elimination of the right bundle branch block QRS morphology, increase in RV filling time (
P
=0.002), pulmonary artery velocity time integral (
P
=0.006), and RV maximum +dP/dt (
P
<0.001), and decrease in RV index of myocardial performance (
P
=0.006). RV mechanical synchrony improved: septal-to-lateral RV mechanical delay decreased (
P
<0.001) and signs of RV dyssynchrony pattern were significantly abolished. RV systolic stretch fraction reflecting the ratio of myocardial stretching and contraction during systole diminished (
P
=0.001).
Conclusions—
In patients with congenital heart disease and right bundle branch block, RV cardiac resynchronization therapy carried multiple positive effects on RV mechanics, synchrony, and contraction efficiency.
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Affiliation(s)
- Jan Janoušek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Jan Kovanda
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Miroslav Ložek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Viktor Tomek
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Pavel Vojtovič
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Roman Gebauer
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Peter Kubuš
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Miroslav Krejčíř
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Joost Lumens
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Tammo Delhaas
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
| | - Frits Prinzen
- From the Children’s Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic (J.J., J.K., M.L., V.T., P.V., R.G., P.K., M.K.); and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, The Netherlands (J.L., T.D., F.P.)
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25
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Zweerink A, Allaart CP, Kuijer JPA, Wu L, Beek AM, van de Ven PM, Meine M, Croisille P, Clarysse P, van Rossum AC, Nijveldt R. Strain analysis in CRT candidates using the novel segment length in cine (SLICE) post-processing technique on standard CMR cine images. Eur Radiol 2017; 27:5158-5168. [PMID: 28656465 PMCID: PMC5674110 DOI: 10.1007/s00330-017-4890-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/14/2017] [Accepted: 05/11/2017] [Indexed: 01/14/2023]
Abstract
Objectives Although myocardial strain analysis is a potential tool to improve patient selection for cardiac resynchronization therapy (CRT), there is currently no validated clinical approach to derive segmental strains. We evaluated the novel segment length in cine (SLICE) technique to derive segmental strains from standard cardiovascular MR (CMR) cine images in CRT candidates. Methods Twenty-seven patients with left bundle branch block underwent CMR examination including cine imaging and myocardial tagging (CMR-TAG). SLICE was performed by measuring segment length between anatomical landmarks throughout all phases on short-axis cines. This measure of frame-to-frame segment length change was compared to CMR-TAG circumferential strain measurements. Subsequently, conventional markers of CRT response were calculated. Results Segmental strains showed good to excellent agreement between SLICE and CMR-TAG (septum strain, intraclass correlation coefficient (ICC) 0.76; lateral wall strain, ICC 0.66). Conventional markers of CRT response also showed close agreement between both methods (ICC 0.61–0.78). Reproducibility of SLICE was excellent for intra-observer testing (all ICC ≥0.76) and good for interobserver testing (all ICC ≥0.61). Conclusions The novel SLICE post-processing technique on standard CMR cine images offers both accurate and robust segmental strain measures compared to the ‘gold standard’ CMR-TAG technique, and has the advantage of being widely available. Key Points • Myocardial strain analysis could potentially improve patient selection for CRT. • Currently a well validated clinical approach to derive segmental strains is lacking. • The novel SLICE technique derives segmental strains from standard CMR cine images. • SLICE-derived strain markers of CRT response showed close agreement with CMR-TAG. • Future studies will focus on the prognostic value of SLICE in CRT candidates. Electronic supplementary material The online version of this article (doi:10.1007/s00330-017-4890-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Joost P A Kuijer
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - LiNa Wu
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Aernout M Beek
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Pierre Croisille
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Patrick Clarysse
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Albert C van Rossum
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.
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26
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Notomi Y, Isomura T, Kanai S, Maeda M, Hoshino J, Kondo T, Fukada Y, Furukawa K. Pre-Operative Left Ventricular Torsion, QRS Width/CRT, and Post-Mitral Surgery Outcomes in Patients With Nonischemic, Chronic, Severe Secondary Mitral Regurgitation. JACC Basic Transl Sci 2016; 1:193-202. [PMID: 30167512 PMCID: PMC6113356 DOI: 10.1016/j.jacbts.2016.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
Abstract
The selection of appropriate candidates for mitral surgery among symptomatic patients with nonischemic, chronic, secondary severe mitral regurgitation (NICSMR) remains a clinical challenge. We studied 50 consecutive symptomatic NICSMR patients for a median follow-up of 2.5 years after mitral surgery and concluded that the pre-operative 2-dimensional speckle tracking echocardiography-derived left ventricular torsional profile and QRS width/cardiac resynchronization therapy are potentially important prognostic indicators for post-surgery survival and reverse remodeling. Determining which patients with NICSMR will benefit from MS is a clinical dilemma. LV torsion (which is a shear strain, not volume strain such as ejection fraction and originates in LV myocardial architectures) may reveal the myopathic conditions and reflect intra-LV electrical conduction. The LV torsional profile predicted post-MS outcomes in NICSMR patients with a narrow QRS but not in those with a wide QRS. The findings may help to resolve the clinical dilemma and identify appropriate candidates for mitral surgery (and other resources) in patients with NICSMR.
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Affiliation(s)
- Yuichi Notomi
- Division of Cardiovascular Imaging, Department of Cardiology, The Hayama Heart Center, Kanagawa, Japan
| | - Tadashi Isomura
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Shunichi Kanai
- Division of Cardiovascular Imaging, Department of Cardiology, The Hayama Heart Center, Kanagawa, Japan
| | - Masami Maeda
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Joji Hoshino
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Taichi Kondo
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Yasuhisa Fukada
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Koji Furukawa
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
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27
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Marek J, Gandalovičová J, Kejřová E, Pšenička M, Linhart A, Paleček T. Echocardiography and cardiac resynchronization therapy. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Werys K, Petryka-Mazurkiewicz J, Błaszczyk Ł, Miśko J, Śpiewak M, Małek ŁA, Mazurkiewicz Ł, Miłosz-Wieczorek B, Marczak M, Kubik A, Dąbrowska A, Piątkowska-Janko E, Sawionek B, Wijesurendra R, Piechnik SK, Bogorodzki P. Cine dyscontractility index: A novel marker of mechanical dyssynchrony that predicts response to cardiac resynchronization therapy. J Magn Reson Imaging 2016; 44:1483-1492. [PMID: 27131044 DOI: 10.1002/jmri.25295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate whether magnetic resonance imaging (MRI) cine-derived dyssynchrony indices provide additional information compared to conventional tagged MRI (tMRI) acquisitions in heart failure patients undergoing cardiac resynchronization therapy (CRT). MATERIALS AND METHODS Patients scheduled for CRT (n = 52) underwent preprocedure MRI including cine and tMRI acquisitions. Segmental strain curves were calculated for both cine and tMRI to produce a range of standard indices for direct comparison between modalities. We also proposed and evaluated a novel index of "dyscontractility," which detects the presence of focal areas with paradoxically positive circumferential strain. RESULTS Across conventional strain indices, there was only moderate-to-poor (R = 0.3-0.6) correlation between modalities; eight cine-derived indices showed statistically significant (P < 0.05) relations to CRT outcome compared to just two tMRI-based counterparts. The novel dyscontractility index calculated on basal slice cine images (cine dyscontractility index, "CDI") was the single best predictor of clinical response to CRT (area under the curve AUC = 0.81, P < 0.001). While poorly correlated to its tMRI counterpart (R = 0.33), CDI performed significantly better in predicting response to CRT (P < 0.005), and was also numerically better than all other tMRI indices (AUC 0.53-0.76, all P for AUC comparisons <0.17). CONCLUSION Cine-derived strain indices offer potentially new information compared to tMRI. Specifically, the novel CDI is most strongly linked to response to cardiac resynchronization therapy in a contemporary patient cohort. It utilizes readily available MRI data, is relatively straightforward to process, and compares favorably with any conventional tagging index. J. Magn. Reson. Imaging 2016;44:1483-1492.
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Affiliation(s)
- Konrad Werys
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland.,Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Łukasz Błaszczyk
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Jolanta Miśko
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Mateusz Śpiewak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Łukasz A Małek
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | | | - Magdalena Marczak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland.,Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Ewa Piątkowska-Janko
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Błażej Sawionek
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Rohan Wijesurendra
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Piotr Bogorodzki
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
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29
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To ACY, Benatti RD, Sato K, Grimm RA, Thomas JD, Wilkoff BL, Agler D, Popović ZB. Strain-time curve analysis by speckle tracking echocardiography in cardiac resynchronization therapy: Insight into the pathophysiology of responders vs. non-responders. Cardiovasc Ultrasound 2016; 14:14. [PMID: 27090784 PMCID: PMC4835914 DOI: 10.1186/s12947-016-0057-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/08/2016] [Indexed: 11/17/2022] Open
Abstract
Background Patients with non-ischemic heart failure etiology and left bundle branch block (LBBB) show better response to cardiac resynchronization therapy (CRT). While these patients have the most pronounced left ventricular (LV) dyssynchrony, LV dyssynchrony assessment often fails to predict outcome. We hypothesized that patients with favorable outcome from CRT can be identified by a characteristic strain distribution pattern. Methods From 313 patients who underwent CRT between 2003 and 2006, we identified 10 patients who were CRT non-responders (no LV end-systolic volume [LVESV] reduction) with non-ischemic cardiomyopathy and LBBB and compared with randomly selected CRT responders (n = 10; LVESV reduction ≥15 %). Longitudinal strain (εlong) data were obtained by speckle tracking echocardiography before and after (9 ± 5 months) CRT implantation and standardized segmental εlong-time curves were obtained by averaging individual patients. Results In responders, ejection fraction (EF) increased from 25 ± 9 to 40 ± 11 % (p = 0.002), while in non-responders, EF was unchanged (20 ± 8 to 21 ± 5 %, p = 0.57). Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT. Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction. Restoration of contraction synchrony was observed in both groups, though non-responder remained low amplitude of εlong. Conclusions CRT non-responders with LBBB and non-ischemic etiology showed a similar improvement of εlong pattern with responders after CRT implantation, while amplitude of εlong remained unchanged. Lower εlong in the non-responders may account for their poor response to CRT.
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Affiliation(s)
- Andrew C Y To
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.,Department of Cardiology, North Shore Hospital, 124 Shakespeare Rd, Takapuna, Auckland, New Zealand
| | - Rodolfo D Benatti
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Kimi Sato
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - James D Thomas
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Bruce L Wilkoff
- Section of Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Deborah Agler
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Zoran B Popović
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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Saporito S, van Assen HC, Houthuizen P, Aben JPMM, Strik M, van Middendorp LB, Prinzen FW, Mischi M. Assessment of left ventricular mechanical dyssynchrony in left bundle branch block canine model: Comparison between cine and tagged MRI. J Magn Reson Imaging 2016; 44:956-63. [PMID: 26973138 DOI: 10.1002/jmri.25225] [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: 12/04/2015] [Accepted: 02/23/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare cine and tagged magnetic resonance imaging (MRI) for left ventricular dyssynchrony assessment in left bundle branch block (LBBB), using the time-to-peak contraction timing, and a novel approach based on cross-correlation. MATERIALS AND METHODS We evaluated a canine model dataset (n = 10) before (pre-LBBB) and after induction of isolated LBBB (post-LBBB). Multislice short-axis tagged and cine MRI images were acquired using a 1.5 T scanner. We computed contraction time maps by cross-correlation, based on the timing of radial wall motion and of circumferential strain. Finally, we estimated dyssynchrony as the standard deviation of the contraction time over the different regions of the myocardium. RESULTS Induction of LBBB resulted in a significant increase in dyssynchrony (cine: 13.0 ± 3.9 msec for pre-LBBB, and 26.4 ± 5.0 msec for post-LBBB, P = 0.005; tagged: 17.1 ± 5.0 msec at for pre-LBBB, and 27.9 ± 9.8 msec for post-LBBB, P = 0.007). Dyssynchrony assessed by cine and tagged MRI were in agreement (r = 0.73, P = 0.0003); differences were in the order of time difference between successive frames of 20 msec (bias: -2.9 msec; limit of agreement: 10.1 msec). Contraction time maps were derived; agreement was found in the contraction patterns derived from cine and tagged MRI (mean difference in contraction time per segment: 3.6 ± 13.7 msec). CONCLUSION This study shows that the proposed method is able to quantify dyssynchrony after induced LBBB in an animal model. Cine-assessed dyssynchrony agreed with tagged-derived dyssynchrony, in terms of magnitude and spatial direction. J. MAGN. RESON. IMAGING 2016;44:956-963.
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Affiliation(s)
- Salvatore Saporito
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Hans C van Assen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Marc Strik
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Lars B van Middendorp
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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31
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Vecera J, Penicka M, Eriksen M, Russell K, Bartunek J, Vanderheyden M, Smiseth OA. Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2016; 17:624-32. [PMID: 26921169 PMCID: PMC4871236 DOI: 10.1093/ehjci/jew019] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/13/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) in heart failure is limited by many non-responders. This study explores whether degree of wasted left ventricular (LV) work identifies CRT responders. Methods and results Twenty-one patients who received CRT according to guidelines were studied before and after 8 ± 3 months. By definition, segments that shorten in systole perform positive work, whereas segments that lengthen do negative work. Work was calculated from non-invasive LV pressure and strain by speckle tracking echocardiography. For each myocardial segment and for the entire LV, wasted work was calculated as negative work in percentage of positive work. LV wall motion score index (WMSI) was assessed by echocardiography. Response to CRT was defined as ≥15% reduction in end-systolic volume (ESV). Responder rate to CRT was 71%. In responders, wasted work for septum was 117 ± 102%, indicating more negative than positive work, and decreased to 14 ± 12% with CRT (P < 0.01). In the LV free wall, wasted work was 19 ± 16% and showed no significant change. Global LV wasted work decreased from 39 ± 21 to 17 ± 7% with CRT (P < 0.01). In non-responders, there were no significant changes. In multiple linear regression analysis, septal wasted work and WMSI were the only significant predictors of ESV reduction (β = 0.14, P = 0.01; β = 1.25, P = 0.03). Septal wasted work together with WMSI showed an area under the curve of 0.86 (95% confidence interval 0.71–1.0) for CRT response prediction. Conclusion Wasted work in the septum together with WMSI was a strong predictor of response to CRT. This novel principle should be studied in future larger studies.
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Affiliation(s)
- J Vecera
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation, Center for Heart Failure Research and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital and University of Oslo, Rikshospitalet, N-0027 Oslo, Norway Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - M Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - M Eriksen
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation, Center for Heart Failure Research and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital and University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
| | - K Russell
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation, Center for Heart Failure Research and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital and University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
| | - J Bartunek
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - O A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation, Center for Heart Failure Research and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital and University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
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Leeters IPM, Davis A, Zusterzeel R, Atwater B, Risum N, Søgaard P, Klem I, Nijveldt R, Wagner GS, Gorgels APM, Kisslo J. Left ventricular regional contraction abnormalities by echocardiographic speckle tracking in combined right bundle branch with left anterior fascicular block compared to left bundle branch block. J Electrocardiol 2016; 49:353-61. [PMID: 26931516 DOI: 10.1016/j.jelectrocard.2016.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In contrast to LBBB patients less is known about patients with RBBB+LAFB regarding LV contractile abnormalities and the potential role of CRT. This study investigated whether patients with RBBB+LAFB morphology have echocardiographic mechanical strain abnormalities between the inferior and anterior LV walls, similar to abnormalities between septal and lateral walls in LBBB. METHODS AND RESULTS Ten healthy volunteers with no-BBB, 28 LBBB and 28 RBBB+LAFB heart failure patients were included in this retrospective study. Two-dimensional regional-strains were obtained by speckle-tracking. Scar was assessed by CMR. Response on echo was defined as normal, classical, borderline or other pattern. The number of classical patterns in LBBB was significantly higher than in RBBB+LAFB and no-BBB groups (p<0.001 for both). Contrary, the RBBB+LAFB group showed a significantly higher number of borderline patterns compared to other groups (LBBB: p=0.042, no-block: p=0.012). In addition, RBBB+LAFB patients had more scar than LBBB patients (9.9% vs 3.4%, p=0.041), and the average amount of scar in each wall was also higher in RBBB+LAFB (<5% in LBBB and <16% in RBBB+LAFB). CONCLUSIONS Patients with RBBB+LAFB on ECG and clinical HF demonstrate echocardiographic wall motion abnormalities between inferior and anterior LV walls, similar to abnormalities found between septal and lateral LV walls in patients with LBBB and HF. Fewer patients with RBBB+LAFB showed a classical pattern of opposing wall motion compared to LBBB. Factors that might alter strain patterns in RBBB+LAFB, including the detailed presence or absence of LV scar and coexisting block of the central fascicle, should be assessed in future studies.
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Affiliation(s)
- Irene P M Leeters
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Ashlee Davis
- Department of Cardiology, Duke University Medical Center, Durham, NC, USA
| | | | - Brett Atwater
- Department of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Søgaard
- Heart Centre and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Igor Klem
- Department of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Galen S Wagner
- Department of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Anton P M Gorgels
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joseph Kisslo
- Department of Cardiology, Duke University Medical Center, Durham, NC, USA
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Zweerink A, de Roest GJ, Wu L, Nijveldt R, de Cock CC, van Rossum AC, Allaart CP. Prediction of Acute Response to Cardiac Resynchronization Therapy by Means of the Misbalance in Regional Left Ventricular Myocardial Work. J Card Fail 2016; 22:133-42. [DOI: 10.1016/j.cardfail.2015.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 01/24/2023]
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Pedrizzetti G, Martiniello AR, Bianchi V, D'Onofrio A, Caso P, Tonti G. Changes in electrical activation modify the orientation of left ventricular flow momentum: novel observations using echocardiographic particle image velocimetry. Eur Heart J Cardiovasc Imaging 2016; 17:203-9. [PMID: 26060201 PMCID: PMC4882880 DOI: 10.1093/ehjci/jev137] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIMS Changes in electrical activation sequence are known to affect the timing of cardiac mechanical events. We aim to demonstrate that these also modify global properties of the intraventricular blood flow pattern. We also explore whether such global changes present a relationship with clinical outcome. METHODS AND RESULTS We investigated 30 heart failure patients followed up after cardiac resynchronization therapy (CRT). All subjects underwent echocardiography before implant and at follow-up after 6+ months. Left ventricular mechanics was investigated at follow-up during active CRT and was repeated after a temporary interruption <5 min later. Strain analysis, performed by speckle tracking, was used to assess the entity of contraction (global longitudinal strain) and its synchronicity (standard deviation of time to peak of radial strain). Intraventricular fluid dynamics, by echographic particle image velocimetry, was used to evaluate the directional distribution of global momentum associated with blood motion. The discontinuation of CRT pacing reflects into a reduction of deformation synchrony and into the deviation of blood flow momentum from the base-apex orientation with the development of transversal flow-mediated haemodynamic forces. The deviation of flow momentum presents a significant correlation with the degree of volumetric reduction after CRT. CONCLUSION Changes in electrical activation alter the orientation of blood flow momentum. The long-term CRT outcome correlates with the degree of re-alignment of haemodynamic forces. These preliminary results suggest that flow orientation could be used for optimizing the biventricular pacing setting. However, larger prospective studies are needed to confirm this hypothesis.
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Affiliation(s)
- Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, P.le Europa 1., Trieste 34127, Italy
| | | | - Valter Bianchi
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Antonio D'Onofrio
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Pio Caso
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Giovanni Tonti
- Cardiology Division, 'G. d'Annunzio' University, Chieti, Italy
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Solovyova O, Katsnelson LB, Kohl P, Panfilov AV, Tsaturyan AK, Tsyvian PB. Mechano-electric heterogeneity of the myocardium as a paradigm of its function. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2015; 120:249-54. [PMID: 26713555 PMCID: PMC4821177 DOI: 10.1016/j.pbiomolbio.2015.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/13/2015] [Accepted: 12/16/2015] [Indexed: 01/25/2023]
Abstract
Myocardial heterogeneity is well appreciated and widely documented, from sub-cellular to organ levels. This paper reviews significant achievements of the group, led by Professor Vladimir S. Markhasin, Russia, who was one of the pioneers in studying and interpreting the relevance of cardiac functional heterogeneity.
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Affiliation(s)
- Olga Solovyova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia; Ural Federal University, Ekaterinburg, Russia.
| | - Leonid B Katsnelson
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia; Ural Federal University, Ekaterinburg, Russia.
| | - Peter Kohl
- Research Centre for Cardiovascular Medicine, University of Freiburg, Germany; National Heart and Lung Institute, Imperial College of London, UK.
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Pluijmert M, Lumens J, Potse M, Delhaas T, Auricchio A, Prinzen FW. Computer Modelling for Better Diagnosis and Therapy of Patients by Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2015; 4:62-7. [PMID: 26835103 PMCID: PMC4711552 DOI: 10.15420/aer.2015.4.1.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 01/20/2015] [Indexed: 11/04/2022] Open
Abstract
Mathematical or computer models have become increasingly popular in biomedical science. Although they are a simplification of reality, computer models are able to link a multitude of processes to each other. In the fields of cardiac physiology and cardiology, models can be used to describe the combined activity of all ion channels (electrical models) or contraction-related processes (mechanical models) in potentially millions of cardiac cells. Electromechanical models go one step further by coupling electrical and mechanical processes and incorporating mechano-electrical feedback. The field of cardiac computer modelling is making rapid progress due to advances in research and the ever-increasing calculation power of computers. Computer models have helped to provide better understanding of disease mechanisms and treatment. The ultimate goal will be to create patient-specific models using diagnostic measurements from the individual patient. This paper gives a brief overview of computer models in the field of cardiology and mentions some scientific achievements and clinical applications, especially in relation to cardiac resynchronisation therapy (CRT).
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Affiliation(s)
- Marieke Pluijmert
- Department of Biomedical Engineering, Cardiovascular Research Institute, Maastricht, The Netherlands;
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute, Maastricht, The Netherlands;
| | - Mark Potse
- Centre for Computational Medicine in Cardiology, Universita della Svizzera Intaliana, Lugano, Switzerland;
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute, Maastricht, The Netherlands;
| | - Angelo Auricchio
- Centre for Computational Medicine in Cardiology, Universita della Svizzera Intaliana, Lugano, Switzerland;
- Fondazione Cardiocentro Ticino, Lugano, Switzerland;
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands
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Saito M, Kaye G, Negishi K, Linker N, Gammage M, Kosmala W, Marwick TH. Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing. Heart 2015; 101:600-8. [DOI: 10.1136/heartjnl-2014-306990] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Solovyova O, Katsnelson LB, Konovalov PV, Kursanov AG, Vikulova NA, Kohl P, Markhasin VS. The cardiac muscle duplex as a method to study myocardial heterogeneity. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:115-28. [PMID: 25106702 PMCID: PMC4210666 DOI: 10.1016/j.pbiomolbio.2014.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/25/2014] [Indexed: 12/14/2022]
Abstract
This paper reviews the development and application of paired muscle preparations, called duplex, for the investigation of mechanisms and consequences of intra-myocardial electro-mechanical heterogeneity. We illustrate the utility of the underlying combined experimental and computational approach for conceptual development and integration of basic science insight with clinically relevant settings, using previously published and new data. Directions for further study are identified.
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Affiliation(s)
- O Solovyova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia.
| | - L B Katsnelson
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - P V Konovalov
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - A G Kursanov
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia
| | - N A Vikulova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - P Kohl
- National Heart and Lung Institute, Imperial College of London, Heart Science Centre, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK; Department of Computer Sciences, University of Oxford, UK
| | - V S Markhasin
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia
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Sohal M, Amraoui S, Chen Z, Sammut E, Jackson T, Wright M, O’Neill M, Gill J, Carr-White G, Rinaldi CA, Razavi R. Combined identification of septal flash and absence of myocardial scar by cardiac magnetic resonance imaging improves prediction of response to cardiac resynchronization therapy. J Interv Card Electrophysiol 2014; 40:179-90. [DOI: 10.1007/s10840-014-9907-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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Vernooy K, van Deursen CJM, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol 2014; 11:481-93. [PMID: 24839977 DOI: 10.1038/nrcardio.2014.67] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.
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Affiliation(s)
- Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | | | - Marc Strik
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
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Wang CL, Powell BD, Redfield MM, Miyazaki C, Fine NM, Olson LJ, Cha YM, Espinosa RE, Hayes DL, Hodge DO, Lin G, Friedman PA, Oh JK. Left ventricular discoordination index measured by speckle tracking strain rate imaging predicts reverse remodelling and survival after cardiac resynchronization therapy. Eur J Heart Fail 2014; 14:517-25. [DOI: 10.1093/eurjhf/hfs025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chun-Li Wang
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
- First Division of Cardiovascular Department; Chang Gung Memorial Hospital and College of Medicine, Chang Gung University; Taoyuan Taiwan
| | - Brian D. Powell
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | | | - Chinami Miyazaki
- Department of Cardiology; Higashisumiyoshi Morimoto Hospital; Osaka Japan
| | - Nowell M. Fine
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Lyle J. Olson
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Raul E. Espinosa
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - David L. Hayes
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - David O. Hodge
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Grace Lin
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Paul A. Friedman
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Jae K. Oh
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
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Foley PW, Chalil S, Khadjooi K, Irwin N, Smith RE, Leyva F. Left ventricular reverse remodelling, long-term clinical outcome, and mode of death after cardiac resynchronization therapy. Eur J Heart Fail 2014; 13:43-51. [DOI: 10.1093/eurjhf/hfq182] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paul W.X. Foley
- Centre for Cardiovascular Sciences; University of Birmingham, Queen Elizabeth Hospital; Birmingham UK
| | - Shajil Chalil
- Centre for Cardiovascular Sciences; University of Birmingham, Queen Elizabeth Hospital; Birmingham UK
| | - Kayvan Khadjooi
- Department of Cardiology; Good Hope Hospital; Sutton Coldfield UK
| | - Nick Irwin
- Department of Cardiology; Good Hope Hospital; Sutton Coldfield UK
| | - Russell E.A. Smith
- Centre for Cardiovascular Sciences; University of Birmingham, Queen Elizabeth Hospital; Birmingham UK
| | - Francisco Leyva
- Centre for Cardiovascular Sciences; University of Birmingham, Queen Elizabeth Hospital; Birmingham UK
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43
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Shimamoto S, Ito T, Nogi S, Kizawa S, Ishizaka N. Left Ventricular Mechanical Discoordination in Nonischemic Hearts: Relationship with Left Ventricular Function, Geometry, and Electrical Dyssynchrony. Echocardiography 2014; 31:1077-84. [DOI: 10.1111/echo.12538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Takahide Ito
- Department of Cardiology; Osaka Medical College; Osaka Japan
| | - Shimpei Nogi
- Department of Cardiology; Osaka Medical College; Osaka Japan
| | - Shun Kizawa
- Department of Cardiology; Osaka Medical College; Osaka Japan
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Affiliation(s)
- Frits W. Prinzen
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Kevin Vernooy
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Angelo Auricchio
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
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45
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Kerckhoffs RCP, Omens JH, McCulloch AD. Mechanical discoordination increases continuously after the onset of left bundle branch block despite constant electrical dyssynchrony in a computational model of cardiac electromechanics and growth. Europace 2013; 14 Suppl 5:v65-v72. [PMID: 23104917 DOI: 10.1093/europace/eus274] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS To test whether a functional growth law leads to asymmetric hypertrophy and associated changes in global and regional cardiac function when integrated with a computational model of left bundle branch block (LBBB). METHODS AND RESULTS In recent studies, we proposed that cardiac myocytes grow longer when a threshold of maximum fibre strain is exceeded and grow thicker when the smallest maximum principal strain in the cellular cross-sectional plane exceeds a threshold. A non-linear cardiovascular model of the beating canine ventricles was combined with the cellular growth law. After inducing LBBB, the ventricles were allowed to adapt in shape over time in response to mechanical stimuli. When subjected to electrical dyssynchrony, the combined model of ventricular electromechanics, haemodynamics, and growth led to asymmetric hypertrophy with a faster increase of wall mass in the left ventricular (LV) free wall (FW) than the septum, increased LV end-diastolic and end-systolic volumes, and decreased LV ejection fraction. Systolic LV pressure decreased during the acute phase of LBBB and increased at later stages. The relative changes of these parameters were similar to those obtained experimentally. Most of the dilation was due to radial and axial fibre growth, and hence altered shape of the LVFW. CONCLUSION Our previously proposed growth law reproduced measured dyssynchronously induced asymmetric hypertrophy and the associated functional changes, when combined with a computational model of the LBBB heart. The onset of LBBB leads to a step increase in LV mechanical discoordination that continues to increase as the heart remodels despite the constant electrical dyssynchrony.
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Affiliation(s)
- Roy C P Kerckhoffs
- Department of Bioengineering, Institute of Engineering in Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412, USA.
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Echocardiographic Assessment of Ventricular Synchrony in Congenital and Acquired Heart Disease in Children. Echocardiography 2013; 30:460-71. [DOI: 10.1111/echo.12110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Noninvasive Assessment of Myocardial Dyssynchrony Prior to Cardiac Resynchronization Therapy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chan YH, Wu LS, Kuo CT, Wang CL, Yeh YH, Ho WJ, Hsu LA. Incremental Value of Inefficient Deformation Indices for Predicting Response to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2013; 26:307-15. [DOI: 10.1016/j.echo.2012.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Indexed: 10/27/2022]
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Iwano H, Yamada S, Watanabe M, Mitsuyama H, Mizukami K, Nishino H, Yokoyama S, Kaga S, Okada K, Nishida M, Yokoshiki H, Mikami T, Tsutsui H. Strain Rate Dispersion Index Can Predict Changes in Left Ventricular Volume and Adverse Cardiac Events Following Cardiac Resynchronization Therapy. Circ J 2013; 77:2757-65. [DOI: 10.1253/circj.cj-13-0483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Masaya Watanabe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Hirofumi Mitsuyama
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Kazuya Mizukami
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Hisao Nishino
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Shinobu Yokoyama
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University
| | - Kazunori Okada
- Division of Health Sciences, Hokkaido University Graduate School of Health Sciences
| | - Mutsumi Nishida
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Markhasin VS, Balakin AA, Katsnelson LB, Konovalov P, Lookin ON, Protsenko Y, Solovyova O. Slow force response and auto-regulation of contractility in heterogeneous myocardium. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2012; 110:305-18. [DOI: 10.1016/j.pbiomolbio.2012.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 08/09/2012] [Indexed: 11/25/2022]
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