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Lee K, Han S, Ryu J, Cho SG, Moon DH. Prognostic value of left ventricular mechanical dyssynchrony indices derived from gated myocardial perfusion SPECT in coronary artery disease: a systematic review and meta-analysis. Ann Nucl Med 2024; 38:441-449. [PMID: 38498236 DOI: 10.1007/s12149-024-01915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Left ventricular mechanical dyssynchrony (LVMD) is an important prognostic factor in coronary artery disease. A growing body of evidence indicates that LVMD parameters derived from phase analysis of gated myocardial SPECT may allow risk stratification for future cardiac events. We performed a systematic review and meta-analysis on the prognostic value of LVMD on gated SPECT in patients with coronary artery disease. METHODS PubMed, Embase, and the Cochrane library were searched until August 25, 2022, for studies reporting the prognostic value of LVMD on gated SPECT for outcomes of all-cause death, cardiac death, or major adverse cardiovascular event (MACE) in patients with coronary artery disease. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were meta-analytically pooled using a random-effects model. RESULTS Nine studies (26,750 patients) were included in a qualitative synthesis. Among the SPECT LVMD parameters used in various studies, high phase standard deviation, phase bandwidth, and phase entropy were widely evaluated and reported to be associated with high rates of all-cause death, cardiac death, or MACE. For five studies (23,973 patients) in the quantitative synthesis, the pooled HR of LVMD for predicting MACE was 2.81 (95% CI 2.03-3.88). Studies using combined phase parameters to define LVMD showed higher HRs than a study using phase entropy (p = 0.0180). CONCLUSION LVMD from gated myocardial SPECT is a significant prognostic factor for coronary artery disease. Phase analysis of gated SPECT may be useful for accurate risk stratification and could be applied for clinical decision-making in such patients.
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Affiliation(s)
- Koeun Lee
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jeongryul Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Republic of Korea
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
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2
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Gui LK, Liu HJ, Jin LJ, Peng XC. Krüpple-like factors in cardiomyopathy: emerging player and therapeutic opportunities. Front Cardiovasc Med 2024; 11:1342173. [PMID: 38516000 PMCID: PMC10955087 DOI: 10.3389/fcvm.2024.1342173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Cardiomyopathy, a heterogeneous pathological condition characterized by changes in cardiac structure or function, represents a significant risk factor for the prevalence and mortality of cardiovascular disease (CVD). Research conducted over the years has led to the modification of definition and classification of cardiomyopathy. Herein, we reviewed seven of the most common types of cardiomyopathies, including Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), diabetic cardiomyopathy, Dilated Cardiomyopathy (DCM), desmin-associated cardiomyopathy, Hypertrophic Cardiomyopathy (HCM), Ischemic Cardiomyopathy (ICM), and obesity cardiomyopathy, focusing on their definitions, epidemiology, and influencing factors. Cardiomyopathies manifest in various ways ranging from microscopic alterations in cardiomyocytes, to tissue hypoperfusion, cardiac failure, and arrhythmias caused by electrical conduction abnormalities. As pleiotropic Transcription Factors (TFs), the Krüppel-Like Factors (KLFs), a family of zinc finger proteins, are involved in regulating the setting and development of cardiomyopathies, and play critical roles in associated biological processes, including Oxidative Stress (OS), inflammatory reactions, myocardial hypertrophy and fibrosis, and cellular autophagy and apoptosis, particularly in diabetic cardiomyopathy. However, research into KLFs in cardiomyopathy is still in its early stages, and the pathophysiologic mechanisms of some KLF members in various types of cardiomyopathies remain unclear. This article reviews the roles and recent research advances in KLFs, specifically those targeting and regulating several cardiomyopathy-associated processes.
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Affiliation(s)
- Le-Kun Gui
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
- School of Medicine, Yangtze University, Jingzhou, Hubei, China
| | - Huang-Jun Liu
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Li-Jun Jin
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Xiao-Chun Peng
- Department of Pathophysiology, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
- Laboratory of Oncology, School of Basic Medicine, Center for Molecular Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
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3
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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4
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_84-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gustafsson F, Shaw S, Lavee J, Saeed D, Pya Y, Krabatsch T, Schmitto J, Morshuis M, Chuang J, Damme L, Zimpfer D, Garbade J. Six-month outcomes after treatment of advanced heart failure with a full magnetically levitated continuous flow left ventricular assist device: report from the ELEVATE registry. Eur Heart J 2018; 39:3454-3460. [DOI: 10.1093/eurheartj/ehy513] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/05/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Finn Gustafsson
- Rigshospitalet, Department of Cardiology, University of Copenhagen 9 Blegdamsvej, Copenhagen, Denmark
| | - Steven Shaw
- Manchester University NHS Foundation Trust, Southmoor Road, Manchester, UK
| | - Jacob Lavee
- Heart Transplantation Unit, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Hasomer, Ramat Gan, Israel
| | - Diyar Saeed
- Cardiovascular Surgery, University Hospital of Duesseldorf, Moorenstrasse 5, Dusseldorf, Germany
| | - Yuriy Pya
- National Research Cardiac Surgery Center, 38 Turan Street, Astana, Kazakhstan
| | | | - Jan Schmitto
- Hannover Medical School, Carl-Neuberg Strasse 1, Hannover, Germany
| | - Michiel Morshuis
- Department of Cardiothoracic Surgery, Herz- und Diabeteszentrum NRW, Georgstrasse 11, Bad Oeynhausen, Germany
| | - Joyce Chuang
- Abbott, Abbott Park Road, Abbott Park, Chicago, IL, USA
| | - Laura Damme
- Abbott, Abbott Park Road, Abbott Park, Chicago, IL, USA
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18–20, Vienna, Austria
| | - Jens Garbade
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Struempellstr. 39, Leipzig, Germany
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Gielgens R, Herold I, van Straten A, van Gelder B, Bracke F, Korsten H, Soliman Hamad M, Bouwman R. The Hemodynamic Effects of Different Pacing Modalities After Cardiopulmonary Bypass in Patients With Reduced Left Ventricular Function. J Cardiothorac Vasc Anesth 2018; 32:259-266. [DOI: 10.1053/j.jvca.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 11/11/2022]
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7
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Should women have different ECG criteria for CRT than men? J Cardiol 2017; 70:1-6. [DOI: 10.1016/j.jjcc.2016.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022]
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8
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Krishnamani NC. DDD pacemaker for severe heart failure-alternate to CRT. Indian Heart J 2017. [PMID: 28648429 PMCID: PMC5485379 DOI: 10.1016/j.ihj.2016.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Patients with severe systolic Heart Failure continue to have poor quality of life and increased mortality in spite of optimal medical management. Cardiac Resynchronization Therapy [CRT] is promising modality in patients with systolic heart failure and electrocardiographic [ECG] evidence of left bundle branch block [LBBB]. Cost issues continue to elude many deserving cases of this therapy in our society. Relatively cost effective Dual chamber pacing [DDD] with right atrial and isolated left ventricular pacing [RA-LV] can be a good alternative.
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9
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Left bundle-branch block contraction patterns identified from radial-strain analysis predicts outcomes following cardiac resynchronization therapy. Int J Cardiovasc Imaging 2017; 33:869-877. [PMID: 28150083 DOI: 10.1007/s10554-017-1083-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
A left bundle-branch block (LBBB) contraction pattern identified from longitudinal-strain analysis predicts outcomes following cardiac resynchronization therapy (CRT). We investigated the use of an LBBB-contraction pattern identified from radial- or circumferential-strain analysis in the prediction of CRT benefits. Eighty CRT candidates were prospectively enrolled. Before CRT implantation, speckle-tracking analyses in three deformation directions were performed to determine whether an LBBB-contraction pattern was present. The study endpoints were reverse remodeling at 6 months, and adverse outcomes including death or heart failure hospitalization. At 6 months, 49 (61%) patients had reverse remodeling. An LBBB-contraction pattern identified from the radial strain in the mid-ventricular short-axis view or longitudinal strain in the four-chamber view provided excellent true-positive (86%) and false-negative (8%) rates for predicting reverse remodeling. During a median follow-up of 30 months, 31 patients (39%) had adverse outcomes. Absence of an LBBB-contraction pattern in radial (hazard ratio 3.74; 95% confidence interval 1.83-7.62) or longitudinal strain (hazard ratio 3.49; 95% confidence interval 1.71-7.13) was significantly associated with an increased risk of adverse outcomes. Adding the LBBB-pattern assessment by radial-(model χ2 from 8.2 to 18.5, p = 0.005), or longitudinal-strain analysis (model χ2 from 8.2 to 16.9, p = 0.011) to a risk model significantly improved the model, including QRS duration and ischemic etiology. In conclusion, an LBBB-contraction pattern identified from radial-strain analysis in the mid-ventricular short-axis view predicted reverse remodeling and outcome following CRT, similarly to the longitudinal-strain analysis.
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10
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Soto Iglesias D, Duchateau N, Kostantyn Butakov CB, Andreu D, Fernandez-Armenta J, Bijnens B, Berruezo A, Sitges M, Camara O. Quantitative Analysis of Electro-Anatomical Maps: Application to an Experimental Model of Left Bundle Branch Block/Cardiac Resynchronization Therapy. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2016; 5:1900215. [PMID: 29164019 PMCID: PMC5477765 DOI: 10.1109/jtehm.2016.2634006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/08/2016] [Accepted: 11/14/2016] [Indexed: 01/02/2023]
Abstract
Electro-anatomical maps (EAMs) are commonly acquired in clinical routine for guiding
ablation therapies. They provide voltage and activation time information on a 3-D
anatomical mesh representation, making them useful for analyzing the electrical
activation patterns in specific pathologies. However, the variability between the
different acquisitions and anatomies hampers the comparison between different maps.
This paper presents two contributions for the analysis of electrical patterns in EAM
data from biventricular surfaces of cardiac chambers. The first contribution is an
integrated automatic 2-D disk representation (2-D bull’s eye plot) of the left
ventricle (LV) and right ventricle (RV) obtained with a quasi-conformal mapping from
the 3-D EAM meshes, that allows an analysis of cardiac resynchronization therapy
(CRT) lead positioning, interpretation of global (total activation time), and local
indices (local activation time (LAT), surrogates of conduction velocity,
inter-ventricular, and transmural delays) that characterize changes in the electrical
activation pattern. The second contribution is a set of indices derived from the
electrical activation: speed maps, computed from LAT values, to study the electrical
wave propagation, and histograms of isochrones to analyze regional electrical
heterogeneities in the ventricles. We have applied the proposed methods to look for
the underlying physiological mechanisms of left bundle branch block (LBBB) and CRT,
with the goal of optimizing the therapy by improving CRT response. To better
illustrate the benefits of the proposed tools, we created a set of synthetically
generated and fully controlled activation patterns, where the proposed representation
and indices were validated. Then, the proposed analysis tools are used to analyze EAM
data from an experimental swine model of induced LBBB with an implanted CRT device.
We have analyzed and compared the electrical activation patterns at baseline, LBBB,
and CRT stages in four animals: two without any structural disease and two with an
induced infarction. By relating the CRT lead location with electrical dyssynchrony,
we evaluated current hypotheses about lead placement in CRT and showed that optimal
pacing sites should target the RV lead close to the apex and the LV one distant from
it.
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Affiliation(s)
- David Soto Iglesias
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra.,Cardiology DepartmentThorax Institute, Hospital Clinic
| | | | | | - David Andreu
- Cardiology DepartmentThorax Institute, Hospital Clinic
| | | | - Bart Bijnens
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra.,Catalan Institution for Research and Advanced Studies
| | | | - Marta Sitges
- Cardiology DepartmentThorax Institute, Hospital Clinic
| | - Oscar Camara
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra
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12
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Niederer SA, Smith NP. Using physiologically based models for clinical translation: predictive modelling, data interpretation or something in-between? J Physiol 2016; 594:6849-6863. [PMID: 27121495 PMCID: PMC5134392 DOI: 10.1113/jp272003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/13/2016] [Indexed: 02/02/2023] Open
Abstract
Heart disease continues to be a significant clinical problem in Western society. Predictive models and simulations that integrate physiological understanding with patient information derived from clinical data have huge potential to contribute to improving our understanding of both the progression and treatment of heart disease. In particular they provide the potential to improve patient selection and optimisation of cardiovascular interventions across a range of pathologies. Currently a significant proportion of this potential is still to be realised. In this paper we discuss the opportunities and challenges associated with this realisation. Reviewing the successful elements of model translation for biophysically based models and the emerging supporting technologies, we propose three distinct modes of clinical translation. Finally we outline the challenges ahead that will be fundamental to overcome if the ultimate goal of fully personalised clinical cardiac care is to be achieved.
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Affiliation(s)
- Steven A. Niederer
- Department of Biomedical Engineering and Imaging SciencesSt Thomas’ HospitalKing's College LondonThe Rayne Institute4th Floor Lambeth WingLondonSE1 7EHUK
| | - Nic P. Smith
- Department of Biomedical Engineering and Imaging SciencesSt Thomas’ HospitalKing's College LondonThe Rayne Institute4th Floor Lambeth WingLondonSE1 7EHUK
- Engineering School Block 1University of AucklandLevel 5, 20 Symonds StreetAuckland101New Zealand
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13
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Wong KA, Hodgson L, Garas G, Malietzis G, Markar S, Rao C, von Segesser LK, Athanasiou T. How can cardiothoracic and vascular medical devices stay in the market? Interact Cardiovasc Thorac Surg 2016; 23:940-948. [DOI: 10.1093/icvts/ivw257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kathie A Wong
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Luke Hodgson
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - George Garas
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - George Malietzis
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Sheraz Markar
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Christopher Rao
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Ludwig K von Segesser
- Department of Cardiovascular Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
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14
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Gloschat CR, Koppel AC, Aras KK, Brennan JA, Holzem KM, Efimov IR. Arrhythmogenic and metabolic remodelling of failing human heart. J Physiol 2016; 594:3963-80. [PMID: 27019074 DOI: 10.1113/jp271992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/21/2016] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a major cause of morbidity and mortality worldwide. The global burden of HF continues to rise, with prevalence rates estimated at 1-2% and incidence approaching 5-10 per 1000 persons annually. The complex pathophysiology of HF impacts virtually all aspects of normal cardiac function - from structure and mechanics to metabolism and electrophysiology - leading to impaired mechanical contraction and sudden cardiac death. Pharmacotherapy and device therapy are the primary methods of treating HF, but neither is able to stop or reverse disease progression. Thus, there is an acute need to translate basic research into improved HF therapy. Animal model investigations are a critical component of HF research. However, the translation from cellular and animal models to the bedside is hampered by significant differences between species and among physiological scales. Our studies over the last 8 years show that hypotheses generated in animal models need to be validated in human in vitro models. Importantly, however, human heart investigations can establish translational platforms for safety and efficacy studies before embarking on costly and risky clinical trials. This review summarizes recent developments in human HF investigations of electrophysiology remodelling, metabolic remodelling, and β-adrenergic remodelling and discusses promising new technologies for HF research.
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Affiliation(s)
- C R Gloschat
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - A C Koppel
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - K K Aras
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - J A Brennan
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - K M Holzem
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - I R Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
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He Z, Sun Y, Gao H, Zhang J, Lu Y, Feng J, Su H, Zeng C, Lv A, Cheng K, Li Y, Li H, Luan R, Wang L, Yu Q. Efficacy and safety of supramaximal titrated inhibition of renin-angiotensin-aldosterone system in idiopathic dilated cardiomyopathy. ESC Heart Fail 2015; 2:129-138. [PMID: 28834619 PMCID: PMC5746969 DOI: 10.1002/ehf2.12042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 11/21/2022] Open
Abstract
Aims The optimal dosing strategies for blocking the renin‐angiotensin‐aldosterone system in idiopathic dilated cardiomyopathy (IDCM) are poorly known. We sought to determine the long‐term efficacy and safety of supramaximal titration of benazepril and valsartan in patients with IDCM. Methods and results 480 patients with IDCM in New York Heart Association functional class II–IV and with left ventricular ejection fraction ≤35% were randomly assigned to extended‐release metoprolol (mean 152 mg/day, range 23.75–190), low‐dose benazepril (20 mg/day), low‐dose valsartan (160 mg/day), high‐dose benazepril (mean 69 mg/day, range 40–80), and high‐dose valsartan (mean 526 mg/day, range 320–640). After a median follow‐up of 4.2 years, high‐dose benazepril and valsartan, compared with their respective low dosages, resulted in 41% and 52% risk reduction in the primary endpoint of all‐cause death or admission for heart failure (P = 0.042 and 0.002), promoted functional improvement, and reversed remodelling as assessed by New York Heart Association classes, quality‐of‐life scores, and echocardiographic recording of left ventricular ejection fraction, left ventricular end‐diastolic volume, mitral regurgitation, and wall motion score index. Compared with metoprolol, high‐dose valsartan reduced risk for the primary endpoint by 46% (P = 0.006), whereas high‐dose benazepril and both low‐dose groups showed no significant difference. Major adverse events involved hypotension and renal impairment but were largely tolerated. Conclusions Supramaximal doses of benazepril and valsartan were well tolerated and produced extra benefit than their low dosages in clinical outcome and cardiac reverse remodelling in patients with IDCM and modest‐severe heart failure. ClinicalTrials.gov identifier: NCT01917149.
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Affiliation(s)
- Zheng He
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yun Sun
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hui Gao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jun Zhang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuhong Lu
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jihua Feng
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongli Su
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chao Zeng
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Anlin Lv
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kang Cheng
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yan Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Huan Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ronghua Luan
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ling Wang
- Department of Statistics, Fourth Military Medical University, Xi'an, China
| | - Qiujun Yu
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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16
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Chen CY, Stevenson LW, Stewart GC, Bhatt DL, Desai M, Seeger JD, Williams L, Jalbert JJ, Setoguchi S. Real world effectiveness of primary implantable cardioverter defibrillators implanted during hospital admissions for exacerbation of heart failure or other acute co-morbidities: cohort study of older patients with heart failure. BMJ 2015; 351:h3529. [PMID: 26174233 PMCID: PMC4501450 DOI: 10.1136/bmj.h3529] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the effectiveness of primary implantable cardioverter defibrillators (ICDs) in elderly patients receiving the device during a hospital admission for exacerbation of heart failure or other acute co-morbidities, with an emphasis on adjustment for early mortality and other factors reflecting healthy candidate bias rather than the effect of the ICD. DESIGN Retrospective cohort study. SETTING Linked data from the Centers for Medicare and Medicaid Services and American College of Cardiology-National Cardiovascular Data Registry ICD registry, nationwide heart failure registry, and Medicare claims data 2004-09. POPULATION 23,111 patients aged ≥ 66 who were admitted to hospital for exacerbation of heart failure or other acute co-morbidities and eligible for primary ICDs. MAIN OUTCOME MEASURES All cause mortality and sudden cardiac death. Latency analyses with Cox regression were used to derive crude hazard ratios and hazard ratios adjusted for high dimension propensity score for outcomes after 180 days from index implantation or discharge. RESULTS Patients who received an ICD during a hospital admission had lower crude mortality risk than patients who did not receive an ICD (40% v 60% at three years); however, with conditioning on 180 day survival and with adjustment for high dimension propensity score, the apparent benefit with ICD was no longer evident for sudden cardiac death (adjusted hazard ratio 0.95, 95% confidence interval 0.78 to 1.17) and had a diminished impact on total mortality (0.91, 0.82 to 1.00). There were trends towards a benefit with ICD in reducing mortality or sudden cardiac death in patients who had had a myocardial infarction more than 40 days previously, left bundle branch block, or low serum B type natriuretic peptide; however, these trends did not reach significance. CONCLUSION After adjustment for healthy candidate bias and confounding, the benefits of primary ICD therapy seen in pivotal trials were not apparent in patients aged 66 or over who received ICDs during a hospital admission for exacerbation of heart failure or other acute co-morbidities. Future research is warranted to further identify subgroups of elderly patients who are more likely to benefit from ICDs. Recognition of those patients whose dominant risk factors are from decompensated heart failure and non-cardiac co-morbidities will allow better focus on ICDs in those patients for whom the device offers the most benefit and provides meaningful prolonging of life.
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Affiliation(s)
- Chih-Ying Chen
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Lynne Warner Stevenson
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Garrick C Stewart
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - John D Seeger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Lauren Williams
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Jessica J Jalbert
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
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Karbasi Afshar R, Ramezani Binabaj M, Rezaee Zavareh MS, Saburi A, Ajudani R. Efficacy of cardiac resynchronization with defibrillator insertion in patients undergone coronary artery bypass graft: a cohort study of cardiac function. Ann Card Anaesth 2015; 18:34-8. [PMID: 25566709 PMCID: PMC4900314 DOI: 10.4103/0971-9784.148319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is a proven therapeutic method in selected patients with heart failure and systolic dysfunction which increases left ventricular function and patient survival. We designed a study that included patients undergoing coronary artery bypass graft (CABG), with and without CRT-defibrillator (CRT-D) inserting and then measured its effects on these two groups. PATIENTS AND METHODS Between 2010 and 2013, we conducted a prospective cohort study on 100 coronary artery disease patients where candidate for CABG. Then based on the receiving CRT-D, the patients were categorized in two groups; Group 1 ( n = 48, with CRT-D insertion before CABG) and Group 2 ( n = 52 without receiving CRT-D). Thereafter both of these groups were followed-up at 1-3 months after CABG for mortality, hospitalization, atrial fibrillation (AF), echocardiographic assessment, and New York Heart Association (NYHA) class level. RESULTS The mean age of participants in Group 1 (48 male) and in Group 2 (52 male) was 58 ± 13 and 57 ± 12 respectively. Difference between Groups 1 and 2 in cases of mean left ventricular ejection fraction (LVEF) changes and NYHA class level was significant ( P > 0.05). Hospitalization ( P = 0.008), mortality rate ( P = 0.007), and AF were significantly different between these two groups. CONCLUSIONS The results showed that the increase in LVEF and patient's improvement according to NYHA-class was significant in the first group, and readmission, mortality rate and AF was increased significantly in the second group.
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_84-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Shuaib W, Shahid H, Khan MS, Alweis R, Sanchez LR. Outcome of prolonged QRS interval in dilated cardiomyopathy: role of implantable cardioverter-defibrillators on mortality. Ther Adv Cardiovasc Dis 2014; 9:36-9. [PMID: 25411353 DOI: 10.1177/1753944714559935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The main objectives of this study were to investigate the relationship between prolonged QRS interval and its prognosis in patients with dilated cardiomyopathy (DCM), and to determine the effects of cardiac pacing with an implantable cardioverter-defibrillator (ICD) on mortality in patients with a QRS width > 150 ms. METHODS We retrospectively queried the healthcare enterprise data warehouse and the patient medical records from January 2007 to December 2012 for 1453 cases of DCM at a university- affiliated hospital. Of the 1453 cases, 989 patients were included in the final analyses. Primary outcome variable was all-cause mortality. RESULTS Of the 989 patients, 20% (n = 198) of the patients had a QRS width > 150 ms. Compared with patients who had a QRS < 120 ms, patients with a QRS > 150 ms had significantly higher rates of death (p < 0.001). Among the subgroup of 198 patients who had a QRS width > 150 ms, survival (84.3%, n = 75) was significantly higher (p < 0.001) in patients with a pacemaker inserted compared with those (45.0%, n = 49) who had not been paced. CONCLUSIONS Prolonged QRS interval is significantly associated with a higher rate of mortality. However, we believe that cardiac pacing with an ICD in such patients can significantly improve outcomes.
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Affiliation(s)
- Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, 550 Peachtree Street NE, Atlanta, GA 02115, USA
| | - Hassan Shahid
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | | | - Richard Alweis
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Laura Rosemary Sanchez
- Department of Cardiology, Hospital Salvador Bienvenido Gautier, Santo Domingo, Dominican Republic
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Hürlimann D, Schmidt S, Seifert B, Saguner AM, Hindricks G, Lüscher TF, Ruschitzka F, Steffel J. Outcome of super-responders to cardiac resynchronization therapy defined by endpoint-derived parameters of left ventricular remodeling: a two-center retrospective study. Clin Res Cardiol 2014; 104:136-44. [DOI: 10.1007/s00392-014-0763-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/26/2014] [Indexed: 12/22/2022]
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CHOUDHURI INDRAJIT, MACCARTER DEAN, SHAW RACHAEL, ANDERSON STEVE, ST. CYR JOHN, NIAZI IMRAN. Clinical Feasibility of Exercise-Based A-V Interval Optimization for Cardiac Resynchronization: A Pilot Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1499-509. [DOI: 10.1111/pace.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 04/18/2014] [Accepted: 05/26/2014] [Indexed: 11/30/2022]
Affiliation(s)
- INDRAJIT CHOUDHURI
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
| | | | - RACHAEL SHAW
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
| | | | | | - IMRAN NIAZI
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Centers; University of Wisconsin School of Medicine and Public Health; Milwaukee Wisconsin
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Petretta M, Petretta A, Pellegrino T, Nappi C, Cantoni V, Cuocolo A. Role of nuclear cardiology for guiding device therapy in patients with heart failure. World J Meta-Anal 2014; 2:1-16. [DOI: 10.13105/wjma.v2.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/20/2013] [Accepted: 12/19/2013] [Indexed: 02/05/2023] Open
Abstract
Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiology and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardiology to guide cardiac resynchronization therapy (CRT) and to select patients for implantable cardioverter defibrillators (ICD). Left ventricular synchrony may be assessed by radionuclide angiography or gated single-photon emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using positron emission tomography and could improve conventional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomography/computed tomography approach for assessing myocardial viability, identifying the location of biventricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Finally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore potentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better define the role of nuclear cardiology for guiding device therapy in patients with heart failure.
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Kim CH, Cha YM, Shen WK, Maccarter DJ, Taylor BJ, Johnson BD. Effects of atrioventricular and interventricular delays on gas exchange during exercise in patients with heart failure. J Heart Lung Transplant 2014; 33:397-403. [PMID: 24594137 DOI: 10.1016/j.healun.2014.01.855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/22/2013] [Accepted: 01/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been an important treatment for heart failure. However, it is controversial as to whether an individualized approach to altering AV and VV timing intervals would improve outcomes. Changes in respiratory patterns and gas exchange are dynamic and may be influenced by timing delays. Light exercise enhances the heart and lung interactions. Thus, in this study we investigated changes in non-invasive gas exchange by altering AV and VV timing intervals during light exercise. METHODS Patients (n = 20, age 66 ± 9 years) performed two walking tests post-implantation. The protocol evaluated AV delays (100, 120, 140, 160 and 180 milliseconds), followed by VV delays (0, -20 and -40 milliseconds) while gas exchange was assessed. RESULTS There was no consistent group pattern of change in gas exchange variables across AV and VV delays (p > 0.05). However, there were modest changes in these variables on an individual basis with variations in VE/VCO2 averaging 10%; O2 pulse 11% and PETCO2 5% across AV delays, and 4%, 8% and 2%, respectively, across VV delays. Delays that resulted in the most improved gas exchange differed from nominal in 17 of 20 subjects. CONCLUSION Gas exchange measures can be improved by optimization of AV and VV delays and thus could be used to individualize the approach to CRT optimization.
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Affiliation(s)
- Chul-Ho Kim
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Win-Kuang Shen
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
| | | | - Bryan J Taylor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Lalonde M, Birnie D, Ruddy TD, deKemp RA, Beanlands RSB, Wassenaar R, Wells RG. SPECT gated blood pool phase analysis of lateral wall motion for prediction of CRT response. Int J Cardiovasc Imaging 2014; 30:559-69. [DOI: 10.1007/s10554-013-0360-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
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25
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Alexandre J, Saloux E, Lebon A, Dugue AE, Lemaitre A, Roule V, Labombarda F, Champ-Rigot L, Gomes S, Pellissier A, Scanu P, Milliez P. Scar extent as a predictive factor of ventricular tachycardia cycle length after myocardial infarction: implications for implantable cardioverter-defibrillator programming optimization. Europace 2013; 16:220-6. [DOI: 10.1093/europace/eut289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gupta A, Dharmarajan K, Dreyer R, Bikdeli B, Chen R, Kulkarni VT, Shi R, Shojaee A, Ranasinghe I. Most Important Outcomes Research Papers on Device Therapies for Cardiomyopathies. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.113.000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kuniyoshi RR, Martinelli M, Negrão CE, Siqueira SF, Rondon MUPB, Trombetta IC, Kuniyoshi FHS, Laterza MC, Nishioka SAD, Costa R, Tamaki WT, Crevelari ES, Peixoto GDL, Ramires JAF, Kalil R. Effects of cardiac resynchronization therapy on muscle sympathetic nerve activity. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:11-8. [PMID: 23952584 DOI: 10.1111/pace.12254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 06/26/2013] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Muscle sympathetic nerve activity (MSNA) is an independent prognostic marker in patients with heart failure (HF). Therefore, its relevance to the treatment of HF patients is unquestionable. OBJECTIVES In this study, we investigated the effects of cardiac resynchronization therapy (CRT) on MSNA response at rest and during exercise in patients with advanced HF. METHODS We assessed 11 HF patients (51 ± 3.4 years; New York Heart Association class III-IV; left ventricular ejection fraction 27.8 ± 2.2%; optimal medical therapy) submitted to CRT. Evaluations were made prior to and 3 months after CRT. MSNA was performed at rest and during moderate static exercise (handgrip). Peak oxygen consumption (VO2 ) was evaluated by means of cardiopulmonary exercise test. HF patients with advanced NYHA class without CRT and healthy individuals were also studied. RESULTS CRT reduced MSNA at rest (48.9 ± 11.1 bursts/min vs 33.7 ± 15.3 bursts/min, P < 0.05) and during handgrip exercise (MSNA 62.3 ± 13.1 bursts/min vs 46.9 ± 14.3 bursts/min, P < 0.05). Among HF patients submitted to CRT, the peak VO2 increased (12.9 ± 2.8 mL/kg/min vs 16.5 ± 3.9 mL/kg/min, P < 0.05) and an inverse correlation between peak VO2 and resting MSNA (r = -0.74, P = 0.01) was observed. CONCLUSIONS In patients with advanced HF and severe systolic dysfunction: (1) a significant reduction of MSNA (at rest and during handgrip) occurred after CRT, and this behavior was significantly superior to HF patients receiving only medical therapy; (2) MSNA reduction after CRT had an inverse correlation with O2 consumption outcomes.
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Wang HX, Li XF, Zhang H, Sun S. Left ventricular endocardial leadless pacing brings new hope to patients with heart failure. Int J Cardiol 2013; 167:1073-4. [DOI: 10.1016/j.ijcard.2012.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/28/2012] [Indexed: 11/29/2022]
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Spotnitz HM, Cabreriza SE, Wang DY, Quinn TA, Cheng B, Bedrosian LN, Aponte-Patel L, Smith CR. Primary endpoints of the biventricular pacing after cardiac surgery trial. Ann Thorac Surg 2013; 96:808-15. [PMID: 23866800 DOI: 10.1016/j.athoracsur.2013.04.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/18/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study sought to determine whether optimized biventricular pacing increases cardiac index in patients at risk of left ventricular dysfunction after cardiopulmonary bypass. Procedures included coronary artery bypass, aortic or mitral surgery and combinations. This trial was approved by the Columbia University Institutional Review Board and was conducted under an Investigational Device Exemption. METHODS Screening of 6,346 patients yielded 47 endpoints. With informed consent, 61 patients were randomized to pacing or control groups. Atrioventricular and interventricular delays were optimized 1 (phase I), 2 (phase II), and 12 to 24 hours (phase III) after bypass in all patients. Cardiac index was measured by thermal dilution in triplicate. A 2-sample t test assessed differences between groups and subgroups. RESULTS Cardiac index was 12% higher (2.83±0.16 [standard error of the mean] vs 2.52±0.13 liters/minute/square meter) in the paced group, less than predicted and not statistically significant (p=0.14). However, when aortic and aortic-mitral surgery groups were combined, cardiac index increased 29% in the paced group (2.90±0.19, n=14) versus controls (2.24±0.15, n=11) (p=0.0138). Using a linear mixed effects model, t-test revealed that mean arterial pressure increased with pacing versus no pacing at all optimization points (phase I 79.2±1.7 vs 74.5±1.6 mm Hg, p=0.008; phase II 75.9±1.5 vs 73.6±1.8, p=0.006; phase III 81.9±2.8 vs 79.5±2.7, p=0.002). CONCLUSIONS Cardiac index did not increase significantly overall but increased 29% after aortic valve surgery. Mean arterial pressure increased with pacing at 3 time points. Additional studies are needed to distinguish rate from resynchronization effects, emphasize atrioventricular delay optimization, and examine clinical benefits of temporary postoperative pacing.
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Affiliation(s)
- Henry M Spotnitz
- Department of Surgery, Columbia Presbyterian Medical Center, New York, New York 10032, USA.
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30
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New insights in LV torsion for the selection of cardiac resynchronisation therapy candidates. Neth Heart J 2013; 19:386-91. [PMID: 21562790 DOI: 10.1007/s12471-011-0136-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Recent literature indicates that torsion of the left ventricle (LV) is a promising predictor for response to cardiac resynchronisation therapy (CRT). Among patients with severe heart failure, 45 to 75% of patients show rigid body rotation, where the base and apex rotate in the same direction, instead of normal, opposite rotation. The occurrence of this phenomenon seems to be a good indicator for response to CRT. From this review, it can be concluded that LV torsion might be a welcome addition to current selection criteria.
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Potential pro-arrhythmic effect of cardiac resynchronization therapy. J Saudi Heart Assoc 2013; 25:181-9. [PMID: 24174858 DOI: 10.1016/j.jsha.2013.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/19/2013] [Accepted: 05/21/2013] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED A decline in mortality due to pump failure has been clearly documented after cardiac resynchronization therapy (CRT), however the impact on sudden cardiac death and the development of malignant ventricular arrhythmias remains questionable. Our study aims to investigate this alleged pro-arrhythmic effect of CRT using surface electrocardiogram (ECG) markers of pro-arrhythmia. METHODS Seventy five patients, who received CRT were included in this study. Manual measurement of corrected QT interval (QTc), Tpeak-end (Tp-e) interval, QT dispersion (QTd) and Tpeak-end dispersion during baseline 12 lead surface ECG and after applying atrial-biventricular pacing were done. Arrhythmias post CRT was recorded from ECG, 24 h holter monitoring or pacemaker programmer event recorder. RESULTS QTc interval showed significant prolongation after CRT (498.9 ± 50.8 vs. 476.2 ± 41.6 msec, P = 0.0001). Comparing patients with major arrhythmogenic events (MAE) and increased frequency of premature ventricular contractions (PVCs) post CRT pacing to those patients without arrhythmias, there was a significant prolongation of the QTc interval (527 ± 63.29 vs. 496.95 ± 45.2 msec, P = 0.043) and Tp-e interval (94.16 ± 9 vs. 87.41 ± 16.37 msec, P = 0.049). While in the arrhythmogenic group, there was an insignificant decrease in QTd and Tpeak-end dispersion. CONCLUSION QTc and Tp-e intervals are a potential predictor of occurrence of MAE and PVCs. On the other hand, Tp-e dispersion and QTd did not show a predictive potential for arrhythmia.
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Galeotti L, van Dam PM, Loring Z, Chan D, Strauss DG. Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations. Europace 2013; 15:1816-21. [DOI: 10.1093/europace/eut132] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Honold J, Fischer-Rasokat U, Seeger FH, Leistner D, Lotz S, Dimmeler S, Zeiher AM, Assmus B. Impact of intracoronary reinfusion of bone marrow-derived mononuclear progenitor cells on cardiopulmonary exercise capacity in patients with chronic postinfarction heart failure. Clin Res Cardiol 2013; 102:619-25. [DOI: 10.1007/s00392-013-0574-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
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Alexandre J, Saloux E, Dugué AE, Lebon A, Lemaitre A, Roule V, Labombarda F, Provost N, Gomes S, Scanu P, Milliez P. Scar extent evaluated by late gadolinium enhancement CMR: a powerful predictor of long term appropriate ICD therapy in patients with coronary artery disease. J Cardiovasc Magn Reson 2013; 15:12. [PMID: 23331500 PMCID: PMC3610203 DOI: 10.1186/1532-429x-15-12] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 01/03/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) patients are at risk for life-threatening ventricular arrhythmias (VA) related to scar tissue. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) can accurately identify myocardial scar extent. It has been shown that scar extent, particularly scar transmurality, percent scar and scar mass, are associated with the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapy. However, quantification of transmurality extent has never been studied. The purpose of our study was to evaluate whether different methods quantifying scar transmurality, percent scar and scar mass (assessed with LGE-CMR) can predict appropriate ICD therapy in CAD patients with a long term follow-up period. METHODS AND RESULTS We enrolled retrospectively 66 patients with chronic CAD referred for primary or secondary preventive ICD implantation and LGE-CMR before ICD implantation. Using LGE-CMR, scar extent was assessed by measuring scar mass, percent scar and transmural scar extent using four different methods. The median follow-up duration was 41.5 months (interquartile range 22-52). The endpoint was the occurrence of appropriate device therapy and occurred in 14 patients. Pre-ICD revascularization and transmural scar extent were significantly associated with the study endpoint but the latter was especially highly dependent on the method used. Patients with appropriate device therapy had also larger scar mass (29.6 ± 14.5 g vs 17.1 ± 8.8 g, p = 0.004), and larger percent scar (15.1 ± 8.2% vs 9.9 ± 5.6%, p = 0.03) than patients without appropriate device therapy. In multivariate analysis, scar extent variables remained significantly associated with the study end-point. CONCLUSIONS In this study of CAD patients implanted for primary or secondary preventive ICD, pre-ICD revascularization and scar extent studied by LGE-CMR were significantly associated with appropriate device therapy and can identify a subgroup of CAD patients with an increased risk of life-threatening VA. Depending of the method used, transmural scar extent may vary significantly and needs further studies to obtain a validated and consensual study method.
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Affiliation(s)
- Joachim Alexandre
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Eric Saloux
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
| | - Audrey Emmanuelle Dugué
- Department of biostatistics and clinical research, CHU de Caen, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
| | - Alain Lebon
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
| | - Adrien Lemaitre
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Vincent Roule
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
| | - Fabien Labombarda
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Nicole Provost
- Department of radiology, CHU de Caen, F-14000, Caen, France
| | - Sophie Gomes
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Patrice Scanu
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
| | - Paul Milliez
- Department of cardiology, CHU de Caen, Avenue de la Côte de Nacre, F-14000, Caen, France
- Université de Caen Basse-Normandie, Medical School, F-14000, Caen, France
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Farmer SA, Tuohy EJ, Small DS, Wang Y, Groeneveld PW. Impact of Community Wealth on Use of Cardiac-Resynchronization Therapy With Defibrillators for Heart Failure Patients. Circ Cardiovasc Qual Outcomes 2012; 5:798-807. [DOI: 10.1161/circoutcomes.112.965509] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Disparities in cardiovascular disease treatment are a major health policy concern. A complex interplay of patient, provider, and social contextual factors affect inequities in care.
Methods and Results—
We used data regarding 22 205 patient stays in the National Cardiovascular Data Registry to explore the effect of hospital resources on receipt of a heart failure therapy, cardiac-resynchronization therapy with defibrillation (CRT-D). When added to patient-level variables, hospital ownership, cardiac patient volume, cardiac procedure availability, CRT-D, implantable cardioverter-defibrillator implantation volumes, and hospital financial characteristics were individually predictive of CRT-D receipt. In the full hierarchical model, average median household income (
P
<0.0001) and implantable cardioverter-defibrillator implantation volume (
P
<0.001) remained significant predictors of CRT-D receipt. Patients treated at hospitals in affluent communities were more likely to receive CRT-D than patients treated in poor communities, despite accounting for other patient and hospital characteristics, including insurance status.
Conclusions—
These findings suggest that the likelihood of receiving CRT-D is mediated by community wealth and hospital resources, and that health policy targeting insurance coverage alone may be ineffective in resolving inequities in care.
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Affiliation(s)
- Steven A. Farmer
- From the Center for Cardiovascular Innovation, Northwestern University School of Medicine, Chicago, IL (S.A.F.); Department of Management and Strategy, Northwestern University Kellogg School of Management, Evanston, IL (S.A.F.); United Health and Vascular Clinic, Inc, St. Paul, MN (E.J.T.); Department of Statistics, University of Pennsylvania Wharton School of Business, Philadelphia, PA (D.S.S.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (Y.W.); Center for
| | - Elizabeth J. Tuohy
- From the Center for Cardiovascular Innovation, Northwestern University School of Medicine, Chicago, IL (S.A.F.); Department of Management and Strategy, Northwestern University Kellogg School of Management, Evanston, IL (S.A.F.); United Health and Vascular Clinic, Inc, St. Paul, MN (E.J.T.); Department of Statistics, University of Pennsylvania Wharton School of Business, Philadelphia, PA (D.S.S.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (Y.W.); Center for
| | - Dylan S. Small
- From the Center for Cardiovascular Innovation, Northwestern University School of Medicine, Chicago, IL (S.A.F.); Department of Management and Strategy, Northwestern University Kellogg School of Management, Evanston, IL (S.A.F.); United Health and Vascular Clinic, Inc, St. Paul, MN (E.J.T.); Department of Statistics, University of Pennsylvania Wharton School of Business, Philadelphia, PA (D.S.S.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (Y.W.); Center for
| | - Yongfei Wang
- From the Center for Cardiovascular Innovation, Northwestern University School of Medicine, Chicago, IL (S.A.F.); Department of Management and Strategy, Northwestern University Kellogg School of Management, Evanston, IL (S.A.F.); United Health and Vascular Clinic, Inc, St. Paul, MN (E.J.T.); Department of Statistics, University of Pennsylvania Wharton School of Business, Philadelphia, PA (D.S.S.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (Y.W.); Center for
| | - Peter W. Groeneveld
- From the Center for Cardiovascular Innovation, Northwestern University School of Medicine, Chicago, IL (S.A.F.); Department of Management and Strategy, Northwestern University Kellogg School of Management, Evanston, IL (S.A.F.); United Health and Vascular Clinic, Inc, St. Paul, MN (E.J.T.); Department of Statistics, University of Pennsylvania Wharton School of Business, Philadelphia, PA (D.S.S.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (Y.W.); Center for
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Balázs T, Merkely B, Bognár E, Zima E. Interaction of intraluminal tissue and coronary sinus lead stabilized with stent placement. J Cardiovasc Electrophysiol 2012; 24:468-70. [PMID: 23066876 DOI: 10.1111/j.1540-8167.2012.02447.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of our investigation was to examine the intraluminal interaction of the vascular tissue and the implanted coronary sinus lead stabilized with stent on two human hearts removed before transplantation. METHODS AND RESULTS The coronary sinus lumen was sectioned under operational microscope and opened carefully. The leads and stents were found separately positioned beside each other completely covered by an intact intimal tissue layer. No sign of occluding proliferative tissue was observed. CONCLUSION Stent fixation technique and extraction of the CS lead in our cases did not have any particular damaging effect on the vascular system.
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Affiliation(s)
- Tibor Balázs
- Department of Materials Science and Engineering, Budapest University of Technology and Economics, Budapest, Hungary.
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García-Bolao I, Calvo N, Gavira JJ, Moreno-Galdós L, Arguedas-Jiménez H, Canepa JP, García-De-Yébenes M. [Current status of cardiac resynchronization therapy]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2012; 82:235-42. [PMID: 23021361 DOI: 10.1016/j.acmx.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 02/27/2012] [Accepted: 04/02/2012] [Indexed: 10/27/2022] Open
Abstract
The present document reviews various aspects of the current status of cardiac resynchronization therapy: mechanisms of action, current indications and implantation technique.
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Affiliation(s)
- Ignacio García-Bolao
- Unidad de Electrofisiología y Arritmias, Departamento de Cardiología y Cirugía Cardiaca, Clínica Universidad de Navarra, Pamplona, España.
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Ginks MR, Shetty AK, Lambiase PD, Duckett SG, Bostock J, Peacock JL, Rhode KS, Bucknall C, Gill J, Taggart P, Leclercq C, Carr-White GS, Razavi R, Rinaldi CA. Benefits of Endocardial and Multisite Pacing Are Dependent on the Type of Left Ventricular Electric Activation Pattern and Presence of Ischemic Heart Disease. Circ Arrhythm Electrophysiol 2012; 5:889-97. [DOI: 10.1161/circep.111.967505] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew R. Ginks
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Anoop K. Shetty
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Pier D. Lambiase
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Simon G. Duckett
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Julian Bostock
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Janet L. Peacock
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Kawal S. Rhode
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Cliff Bucknall
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Jaswinder Gill
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Peter Taggart
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Christophe Leclercq
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Gerald S. Carr-White
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - Reza Razavi
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
| | - C. Aldo Rinaldi
- From the St. Thomas’ Hospital (M.R.G., A.K.S., J.B., C.B., J.G., G.S.C.-W., A.R.), The Heart Hospital (P.D.L.), University College Hospital (P.D.L., P.T.), and King’s College, London, United Kingdom (S.G.D., J.L.P., K.S.R., R.R.); and University Hospital, Rennes, France (C.L.)
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Babbs CF. Optimizing electrode placement for hemodynamic benefit in cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1135-45. [PMID: 22762433 DOI: 10.1111/j.1540-8159.2012.03454.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Research is needed to explore the relative benefits of alternative electrode placements in biventricular and left ventricular (LV) pacing for heart failure with left bundle branch block (LBBB). METHODS A fast computational model of the left ventricle, running on an ordinary laptop computer, was created to simulate the spread of electrical activation over the myocardial surface, together with the resulting electrocardiogram, segmental wall motion, stroke volume, and ejection fraction in the presence of varying degrees of mitral regurgitation. Arbitrary zones of scar and blocked electrical conduction could be modeled. RESULTS Simulations showed there are both sweet spots and poor spots for LV electrode placement, sometimes separated by only a few centimeters. In heart failure with LBBB, pacing at poor spots can produce little benefit or even reduce pumping effectiveness. Pacing at sweet spots can produce up to 35% improvement in ejection fraction. Relatively larger benefit occurs in dilated hearts, in keeping with the greater disparity between early and late activated muscle. Sweet spots are typically located on the basal to midlevel, inferolateral wall. Poor spots are located on or near the interventricular septum. Anteroapical scar with conduction block causes little shift in locations for optimal pacing. Hearts with increased passive ventricular compliance and absence of preejection mitral regurgitation exhibit greater therapeutic gain. The durations and wave shapes of QRS complexes in the electrocardiogram can help predict optimum electrode placement in real time. CONCLUSIONS Differences between poor responders and hyperresponders to cardiac resynchronization therapy can be understood in terms of basic anatomy, physiology, and pathophysiology. Computational modeling suggests general strategies for optimal electrode placement. In a given patient heart size, regional pathology and regional dynamics allow individual pretreatment planning to target optimal electrode placement.
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Affiliation(s)
- Charles F Babbs
- Department of Basic Medical Sciences, 1246 Lynn Hall, 625 Harrison Street, Purdue University, West Lafayette, Indiana 47907, USA.
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Thijssen J, van Rees JB, Venlet J, Borleffs CJW, Höke U, Putter H, van der Velde ET, van Erven L, Schalij MJ. The mode of death in implantable cardioverter-defibrillator and cardiac resynchronization therapy with defibrillator patients: results from routine clinical practice. Heart Rhythm 2012; 9:1605-12. [PMID: 22522066 DOI: 10.1016/j.hrthm.2012.04.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although data on the mode of death of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with defibrillator (CRT-D) patients have been examined in randomized clinical trials, in routine clinical practice data are scarce. To provide reasonable expectations and prognosis for patients and physicians, this study assessed the mode of death in routine clinical practice. OBJECTIVE To assess the mode of death in ICD/CRT-D recipients in routine clinical practice. METHODS All patients who underwent an ICD or CRT-D implantation at the Leiden University Medical Center, the Netherlands, between 1996 and 2010 were included. Patients were divided into primary prevention ICD, secondary prevention ICD, and CRT-D patients. For patients who died during follow-up, the mode of death was retrieved from hospital and general practitioner records and categorized according to a predetermined classification: heart failure death, other cardiac death, sudden death, noncardiac death, and unknown death. RESULTS A total of 2859 patients were included in the analysis. During a median follow-up of 3.4 years (interquartile range 1.7-5.7 years), 107 (14%) primary prevention ICD, 253 (28%) secondary prevention ICD, and 302 (25%) CRT-D recipients died. The 8-year cumulative incidence of all-cause mortality was 39.9% (95% confidence interval 37.0%-42.9%). Heart failure death and noncardiac death were the most common modes of death for all groups. Sudden death accounted for approximately 7%-8% of all deaths. CONCLUSION For all patients, heart failure and noncardiac death are the most common modes of death. The proportion of patients who died suddenly was low and comparable for primary and secondary ICD and CRT-D patients.
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Affiliation(s)
- Joep Thijssen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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41
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Cardiac resynchronization therapy to prevent life-threatening arrhythmias in patients with congestive heart failure. J Electrocardiol 2012; 44:736-41. [PMID: 22018488 DOI: 10.1016/j.jelectrocard.2011.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Indexed: 11/23/2022]
Abstract
Various clinical data demonstrate that cardiac resynchronization therapy (CRT) provides a favorable structural as well as electrical remodeling. The CArdiac Resynchronization-Heart Failure study, which tested the pure effect of CRT (using CRT devices without the capability of defibrillation) clearly showed a significant reduction in the total mortality by partly preventing sudden cardiac death. The antiarrhythmic effects of CRT are explained, at least in part, by ionic and genetic modulation of ventricular myocytes. It has been revealed in animal experiments to mimic disorganized ventricular contraction that CRT reverses down-regulation of certain K(+) channels and abnormal Ca(2+) homeostasis in the failing heart. However, CRT can be proarrhythmic in some particular cases especially in the early phase of this therapy. According to our study, proarrhythmic effects after CRT can be observed in approximately 10% of patients. The relatively high incidence of the proarrhythmic effects of CRT may promote a trend toward selecting CRT-D rather than CRT-P.
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42
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Russo C, Jaubert MP, Jin Z, Homma S, Di Tullio MR. Intra- and Interobserver Reproducibility of Left Ventricular Mechanical Dyssynchrony Assessment by Real Time Three-Dimensional Echocardiography. Echocardiography 2012; 29:598-607. [DOI: 10.1111/j.1540-8175.2011.01655.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
The quest to discover effective methodologies to monitor the course of disease and response to therapeutic agents in patients with chronic heart failure continues. Clinical trials of specific therapeutic agents have shown efficacy in large groups of patients, but the outcome even with the most effective agents is recognized to be heterogeneous for largely unexplained reasons. The idea that the treatment of individual patients with heart failure could be guided by serial measurements of surrogate end points for mortality and morbidity remains attractive to clinicians. A new approach for clinicians is the guiding of heart failure care by hemodynamic implantable sensors, and in this paper, a brief review of the implantable technologies available to assess cardiac function for monitoring the course of chronic heart failure (CHF) is presented. Early results suggest that measurements arising from these implantable devices should help in guiding the long-term management of CHF patients. Careful consideration of measurements to make, end points to assess, and therapy in control patients will be essential in validating new approaches.
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Affiliation(s)
- G. PLICCHI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no. 9, 40138 Bologna, Italy
| | - E. MARCELLI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no. 9, 40138 Bologna, Italy
| | - L. CERCENELLI
- Surgery and Transplantation Department, University of Bologna — via Massarenti no. 9, 40138 Bologna, Italy
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Johnson L, Lamia B, Kim HK, Tanabe M, Gorcsan J, Schwartzman D, Shroff SG, Pinsky MR. Physiological relevance of quantifying segmental contraction synchrony. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:174-87. [PMID: 22017611 DOI: 10.1111/j.1540-8159.2011.03246.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most current indices of synchrony quantify left ventricular (LV) contraction pattern in terms of a single, global (integrated) measure. We report the development and physiological relevance of a novel method to quantify LV segmental contraction synchrony. METHODS LV pressure-volume and echocardiographic data were collected in seven anesthetized, opened-chest dogs under several pacing modes: right atrial (RA) (control), right ventricular (RV) (dyssynchrony), and additional LV pacing at either apex (CRTa) or free wall (CRTf). Cross-correlation-based integrated (CCSI(int) ) and segmental (CCSI(seg) ) measures of synchrony were calculated from speckle-tracking derived radial strain, along with a commonly used index (maximum time delay). LV contractility was quantified using either E(es) (ESPVR slope) or ESPVR(area) (defined in the manuscript). RESULTS RV pacing decreased CCSI(int) at LV base (0.95 ± 0.02 [RA] vs 0.64 ± 0.14 [RV]; P < 0.05) and only CRTa improved it (0.93 ± 0.03; P < 0.05 vs RV). The CCSI(seg) analysis identified anteroseptal and septal segments as being responsible for the low CCSI(int) during RV pacing and inferior segment for poor resynchronization with CRTf. Changes in ESPVR(area) , and not in E(es) , indicated depressed LV contractility with RV pacing, an observation consistent with significantly decreased global LV performance (stroke work [SW]: 252 ± 23 [RA] vs 151 ± 24 [RV] mJ; P < 0.05). Only CRTa improved SW and contractility (SW: 240 ± 19 mJ; ESPVR(area) : 545 ± 175 mmHg•mL; both P < 0.01 vs RV). Only changes in CCSI(seg) and global LV contractility were strongly correlated (R(2) = 0.698, P = 0.005). CONCLUSION CCSI(seg) provided insights into the changes in LV integrated contraction pattern and a better link to global LV contractility changes.
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Affiliation(s)
- Lauren Johnson
- Cardiovascular Systems Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Rusanov A, Wang DY, Cabreriza SE, Bedrosian LN, Karl SR, Richmond ME, Quinn TA, Cheng B, Spotnitz HM. Effect of atrioventricular conduction prolongation on optimization of paced atrioventricular delay for biventricular pacing after cardiac surgery. J Cardiothorac Vasc Anesth 2011; 26:209-16. [PMID: 22000982 DOI: 10.1053/j.jvca.2011.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Atrioventricular conduction prolongation (AVCP) in cardiac pacing is measurable and results primarily from delayed atrial conduction. Noninvasive methods for measuring atrial conduction are lacking. Accordingly, AVCP was used to estimate atrial conduction and investigate its role on the paced atrioventricular delay (pAVD) during biventricular pacing (BiVP) optimization. DESIGN Retrospective analysis of data collected as part of a randomized controlled study of temporary BiVP after cardiopulmonary bypass. SETTING Single-center study at university-affiliated tertiary care hospital. PARTICIPANTS Cardiac surgical patients at risk of left ventricular failure after cardiopulmonary bypass. INTERVENTIONS Temporary BiVP was optimized immediately after cardiopulmonary bypass. Vasoactive medication and fluid infusion rates were held constant during optimization. MEASUREMENTS AND MAIN RESULTS For each patient the AVCP and the pAVD producing the optimum (highest) cardiac output (OptCO) and mean arterial pressure (OptMAP) were determined. Patients were stratified into long- and short-AVCP groups. Overall AVCP (mean ± standard deviation) was 64 ± 28 ms. For the short-AVCP group (<64 ms, n = 3), AVCP, OptCO, and OptMAP were 40 ± 11, 120 ± 0, and 150 ± 30 ms, respectively, and for the long-AVCP group (>64 ms, n = 4), these same parameters were 89 ± 10, 218 ± 44, and 218 ± 29 ms. OptCO and OptMAP were significantly less in the short-AVCP group (p = 0.015 and p = 0.029, respectively). CONCLUSIONS AVCP varies widely after cardiopulmonary bypass, affecting optimum pAVD. Failure to correct for this can result in the selection of inappropriately short and potentially deleterious pAVDs, especially when nominal pAVD is used, causing BiVP to appear ineffective.
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Affiliation(s)
- Alexander Rusanov
- Department of Anesthesiology, Columbia University Medical Center, New York, NY 10032, USA.
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van Bommel RJ, Marsan NA, Delgado V, Borleffs CJW, van Rijnsoever EP, Schalij MJ, Bax JJ. Cardiac Resynchronization Therapy as a Therapeutic Option in Patients With Moderate-Severe Functional Mitral Regurgitation and High Operative Risk. Circulation 2011; 124:912-9. [DOI: 10.1161/circulationaha.110.009803] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background—
Functional mitral regurgitation (MR) is a common finding in heart failure patients with dilated cardiomyopathy and has important prognostic implications. However, the increased operative risk of these patients may result in low referral or high denial rate for mitral valve surgery. Cardiac resynchronization therapy (CRT) has been shown to have a favorable effect on MR. Aims of this study were to (1) evaluate CRT as a therapeutic option in heart failure patients with functional MR and high operative risk and (2) investigate the effect of MR improvement after CRT on prognosis.
Methods and Results—
A total of 98 consecutive patients with moderate-severe functional MR and high operative risk underwent CRT according to current guidelines. Echocardiography was performed at baseline and 6-month follow-up; severity of MR was graded according to a multiparametric approach. Significant improvement of MR was defined as a reduction ≥1 grade. All-cause mortality was assessed during follow-up (median 32 [range 6.0 to 116] months). Thirteen patients (13%) died before 6-months follow-up. In the remaining 85 patients, significant reduction in MR was observed in all evaluated parameters. In particular, 42 patients (49%) improved ≥1 grade of MR and were considered MR improvers. Survival was superior in MR improvers compared to MR nonimprovers (log rank
P
<0.001). Mitral regurgitation improvement was an independent prognostic factor for survival (hazard ratio 0.35, confidence interval 0.13 to 0.94;
P
=0.043).
Conclusions—
Cardiac resynchronization therapy is a potential therapeutic option in heart failure patients with moderate-severe functional MR and high risk for surgery. Improvement in MR results in superior survival after CRT.
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Affiliation(s)
- Rutger J. van Bommel
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - C. Jan Willem Borleffs
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eva P.M. van Rijnsoever
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J. Schalij
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J. Bax
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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DeFaria Yeh D, Lonergan KL, Fu D, Yeh RW, Echt DS, Foster E. Clinical factors and echocardiographic techniques related to the presence, size, and location of acoustic windows for leadless cardiac pacing. Europace 2011; 13:1760-5. [PMID: 21798878 DOI: 10.1093/europace/eur199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Temporary leadless cardiac pacing using ultrasound energy is feasible in patients. An implantable left ventricular stimulation system being developed for cardiac resynchronization therapy transfers energy from a subcutaneous transmitter to an endocardial receiver through tissue free of interfering lung or rib ('acoustic window'). The aim was to use transthoracic echocardiography to evaluate acoustic window (AW) locations and sizes to determine the implant site for a transmitter, and to investigate clinical predictors of AW location and size. METHODS AND RESULTS Inclusion criteria were ejection fraction ≤35%, and New York Heart Association functional class III or IV. Acoustic windows were evaluated in intercostal spaces (ICSs) measured in the supine, right lateral, sitting, and standing position during normal respiration and held inspiration. Among 42 patients, at least one adequate AW (≥2 cm(2)) was identified in 41, 19 patients had adequate AWs in 2 ICSs and 20 patients had adequate AWs in 3. Acoustic window areas were generally smallest in the lateral position with held inspiration and largest in the standing position with normal respiration. Patients with ischaemic cardiomyopathy compared with non-ischaemic cardiomyopathy had smaller heart size [left ventricular end-systolic volume index (LVESVI) 78 ± 38 mL/m(2) vs. 104 ± 46 mL/m(2), P = 0.03] but larger AWs in the right lateral position (11.4 ± 6.5 cm(2) vs. 7.3 ± 3.4 cm(2), P = 0.01) and standing position (14.0 ± 7.2 cm(2) vs. 9.4 ± 3.3 cm(2), P = 0.02). CONCLUSIONS Adequate AWs were present in nearly all patients. Despite smaller hearts, ischaemic cardiomyopathy patients had adequate AWs. A simple procedure performed as an adjunct to pre-implant echocardiography can screen patients and identify transmitter implant locations for an ultrasound-mediated leadless pacing system.
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Camara O, Sermesant M, Lamata P, Wang L, Pop M, Relan J, De Craene M, Delingette H, Liu H, Niederer S, Pashaei A, Plank G, Romero D, Sebastian R, Wong KCL, Zhang H, Ayache N, Frangi AF, Shi P, Smith NP, Wright GA. Inter-model consistency and complementarity: learning from ex-vivo imaging and electrophysiological data towards an integrated understanding of cardiac physiology. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2011; 107:122-33. [PMID: 21791225 DOI: 10.1016/j.pbiomolbio.2011.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/01/2011] [Indexed: 11/27/2022]
Abstract
Computational models of the heart at various scales and levels of complexity have been independently developed, parameterised and validated using a wide range of experimental data for over four decades. However, despite remarkable progress, the lack of coordinated efforts to compare and combine these computational models has limited their impact on the numerous open questions in cardiac physiology. To address this issue, a comprehensive dataset has previously been made available to the community that contains the cardiac anatomy and fibre orientations from magnetic resonance imaging as well as epicardial transmembrane potentials from optical mapping measured on a perfused ex-vivo porcine heart. This data was used to develop and customize four models of cardiac electrophysiology with different level of details, including a personalized fast conduction Purkinje system, a maximum a posteriori estimation of the 3D distribution of transmembrane potential, the personalization of a simplified reaction-diffusion model, and a detailed biophysical model with generic conduction parameters. This study proposes the integration of these four models into a single modelling and simulation pipeline, after analyzing their common features and discrepancies. The proposed integrated pipeline demonstrates an increase prediction power of depolarization isochrones in different pacing conditions.
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Affiliation(s)
- O Camara
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Universitat Pompeu Fabra, Barcelona, Spain.
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49
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Li Y, Garson CD, Xu Y, Helm PA, Hossack JA, French BA. Serial ultrasound evaluation of intramyocardial strain after reperfused myocardial infarction reveals that remote zone dyssynchrony develops in concert with left ventricular remodeling. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1073-1086. [PMID: 21640480 PMCID: PMC3119373 DOI: 10.1016/j.ultrasmedbio.2011.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 03/14/2011] [Accepted: 04/04/2011] [Indexed: 05/30/2023]
Abstract
This study noninvasively evaluated the development of left ventricular (LV) dyssynchrony following reperfused myocardial infarction (MI) in mice using an ultrasonic speckle-tracking method. Eight C57BL/6J mice were assessed by high-resolution echocardiography at baseline and at eight time-points following MI. Images were acquired at 1mm elevational intervals encompassing the entire LV to determine chamber volumes and radial strain. Receiver-operating characteristic (ROC) analysis of regional radial strain was used to segment the three-dimensional (3-D) LV into infarct, adjacent and remote zones. This in vivo segmentation was correlated to histologic infarct size (R = 0.89, p < 0.01) in a short-axis, slice-by-slice comparison. The onset of dyssynchrony during LV remodeling was assessed by standard deviation of time to peak radial strain in the infarct, adjacent and remote zones. It was discovered that the form of LV dyssynchrony that develops in the remote zone late after MI does so in concert with the progression of LV remodeling (R = 0.70, p < 0.05).
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Affiliation(s)
- Yinbo Li
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Christopher D. Garson
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Yaqin Xu
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | | | - John A. Hossack
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Brent A. French
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
- Radiology, University of Virginia, Charlottesville, VA, USA
- Medicine, University of Virginia, Charlottesville, VA, USA
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Doganay S, Karaman A, Gündogdu F, Duran C, Yalcin A, Kantarci M. Usefulness of multidetector computed tomography coronary venous angiography examination before cardiac resynchronization therapy. Jpn J Radiol 2011; 29:342-7. [DOI: 10.1007/s11604-011-0565-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/16/2011] [Indexed: 12/01/2022]
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