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Manganaro R, Cusmà-Piccione M, Carerj S, Licordari R, Khandheria BK, Zito C. Echocardiographic Patterns of Abnormal Septal Motion: Beyond Myocardial Ischemia. J Am Soc Echocardiogr 2023; 36:1140-1153. [PMID: 37574150 DOI: 10.1016/j.echo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
Abnormal septal motion (ASM), which often is associated with myocardial ischemia, is also observed in other diseases. Owing to the position of the interventricular septum (IVS) in the heart, its movement not only relies on contractile properties but is also affected by the pressure gradient between the 2 ventricles and by the mode of electrical activation. Echocardiography allows the operator to focus on the motion of the IVS, analyzing its characteristics and thereby gaining information about the possible underlying pathophysiological mechanism. In this review, we focused on the main echocardiographic patterns of ASM that are not related to a failure of contractile properties of the septum (i.e., acute coronary syndrome and cardiomyopathies), showing their pathophysiological mechanisms and underlining their diagnostic usefulness in clinical practice.
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Affiliation(s)
- Roberta Manganaro
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Maurizio Cusmà-Piccione
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, Wisconsin
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
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2
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Zhu K, Li L, Liu J, Chang D, Li Q. Criteria for differentiating left bundle branch pacing and left ventricular septal pacing: A systematic review. Front Cardiovasc Med 2022; 9:1006966. [PMID: 36247445 PMCID: PMC9562849 DOI: 10.3389/fcvm.2022.1006966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background As a novel physiological pacing technique, left bundle branch pacing (LBBP) can preserve the left ventricular (LV) electrical and mechanical synchronization by directly capturing left bundle branch (LBB). Approximately 60-90% of LBBP were confirmed to have captured LBB during implantation, implying that up to one-third of LBBP is actually left ventricular septal pacing (LVSP). LBB capture is critical for distinguishing LBBP from LVSP. Methods and results A total of 15 articles were included in the analysis by searching PubMed, EMBASE, Web of Science, and the Cochrane Library database till August 2022. Comparisons of paced QRS duration between LVSP and LBBP have not been uniformly concluded, but the stimulus artifact to LV activation time in lead V5 or V6 (Stim-LVAT) was shorter in LBBP than LVSP in all studies. Stim-LVAT was used to determine LBB capture with a sensitivity of 76-95.2% and specificity of 78.8-100%, which varied across patient populations. Conclusion The output-dependent QRS transition from non-selective LBBP to selective LBBP or LVSP is direct evidence of LBB capture. LBB potential combined with short Stim-LVAT can predict LBB capture better. Personalized criteria rather than a fixed value of Stim-LVAT are necessary to confirm LBB capture in different populations, especially in patients with LBB block or heart failure.
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Affiliation(s)
- Kailun Zhu
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Linlin Li
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jianghai Liu
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Dong Chang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qiang Li
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Rijks J, Luermans J, Heckman L, van Stipdonk AMW, Prinzen F, Lumens J, Vernooy K. Physiology of Left Ventricular Septal Pacing and Left Bundle Branch Pacing. Card Electrophysiol Clin 2022; 14:181-189. [PMID: 35715076 DOI: 10.1016/j.ccep.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following the recognition of the adverse effects of right ventricular pacing, alternative permanent pacing strategies aiming to maintain a synchronous ventricular contraction have been sought. The quest for the optimal pacing site has recently led to several promising and rapidly emerging new pacing strategies, such as left ventricular septal pacing and left bundle branch pacing. In both animal and human studies, these pacing strategies seem to maintain electrical and mechanical activation of the left ventricle to a (near)physiologic level. However, more studies on the long-term effects of both strategies are needed.
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Affiliation(s)
- Jesse Rijks
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), the Netherlands; Department of Cardiology, Radboud University Medical Centre (RadboudUMC), Nijmegen, the Netherlands
| | - Luuk Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Frits Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), the Netherlands; Department of Cardiology, Radboud University Medical Centre (RadboudUMC), Nijmegen, the Netherlands.
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4
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Heckman L, Luermans J, Salden F, van Stipdonk AMW, Mafi-Rad M, Prinzen F, Vernooy K. Physiology and Practicality of Left Ventricular Septal Pacing. Arrhythm Electrophysiol Rev 2021; 10:165-171. [PMID: 34777821 PMCID: PMC8576493 DOI: 10.15420/aer.2021.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/08/2021] [Indexed: 02/01/2023] Open
Abstract
Left ventricular septal pacing (LVSP) and left bundle branch pacing (LBBP) have been introduced to maintain or correct interventricular and intraventricular (dys)synchrony. LVSP is hypothesised to produce a fairly physiological sequence of activation, since in the left ventricle (LV) the working myocardium is activated first at the LV endocardium in the low septal and anterior free-wall regions. Animal studies as well as patient studies have demonstrated that LV function is maintained during LVSP at levels comparable to sinus rhythm with normal conduction. Left ventricular activation is more synchronous during LBBP than LVSP, but LBBP produces a higher level of intraventricular dyssynchrony compared to LVSP. While LVSP is fairly straightforward to perform, targeting the left bundle branch area may be more challenging. Long-term effects of LVSP and LBBP are yet to be determined. This review focuses on the physiology and practicality of LVSP and provides a guide for permanent LVSP implantation.
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Affiliation(s)
- Luuk Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), the Netherlands.,Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - Floor Salden
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), the Netherlands
| | | | - Masih Mafi-Rad
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), the Netherlands
| | - Frits Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), the Netherlands.,Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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Gurzău D, Dădârlat-Pop A, Caloian B, Cismaru G, Comşa H, Tomoaia R, Zdrenghea D, Pop D. Major Left Bundle Branch Block and Coronary Heart Disease-Are There Any Differences between the Sexes? J Clin Med 2021; 10:jcm10112284. [PMID: 34070288 PMCID: PMC8197312 DOI: 10.3390/jcm10112284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022] Open
Abstract
Left bundle branch block is not a benign pathology, and its presence requires the identification of a pathological substrate, such as ischemic heart disease. Left bundle branch block appears to be more commonly associated with normal coronary arteries, especially in women. The objectives of our study were to describe the particularities of left bundle branch block in women compared to men with ischemic heart disease. Result: We included seventy patients with left bundle branch block and ischemic heart disease, with a mean age of 67.01 ± 8.89 years. There were no differences in the profile of risk factors, except for smoking and uric acid. The ventricular depolarization (QRS) duration was longer in men than women (136.86 ± 8.32 vs. 132.57 ± 9.19 msec; p = 0.018) and also men were observed to have larger left ventricular diameters. Left bundle branch block duration was directly associated with ventricular diameters and indirectly associated with left ventricular ejection fraction value, especially in women (R = −0.52, p = 0.0012 vs. R = −0.50, p = 0.002). In angiography, 80% of women had normal epicardial arteries compared with 65.7% of men; all these patients presented with microvascular dysfunction. Conclusion: The differences between the sexes were not so obvious in terms of the presence of risk factors; instead, there were differences in electrocardiographic, echocardiographic, and angiographic aspects. Left bundle branch block appears to be a marker of microvascular angina and systolic dysfunction, especially in women.
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Storsten P, Aalen JM, Boe E, Remme EW, Gjesdal O, Larsen CK, Andersen ØS, Eriksen M, Kongsgaard E, Duchenne J, Voigt JU, Smiseth OA, Skulstad H. Mechanical Effects on Right Ventricular Function From Left Bundle Branch Block and Cardiac Resynchronization Therapy. JACC Cardiovasc Imaging 2020; 13:1475-1484. [DOI: 10.1016/j.jcmg.2019.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/15/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022]
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Lyon S, Dandamudi G, Kean AC. Permanent His-bundle Pacing in Pediatrics and Congenital Heart Disease. J Innov Card Rhythm Manag 2020; 11:4005-4012. [PMID: 32368373 PMCID: PMC7192153 DOI: 10.19102/icrm.2020.110205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/09/2019] [Indexed: 01/20/2023] Open
Abstract
Permanent His-bundle pacing has been gaining popularity in the adult population requiring cardiac resynchronization therapy. Initial procedural challenges are being overcome, and this method of pacing has been shown to improve left ventricular function and heart failure symptoms secondary to ventricular dyssynchrony. Though the etiologies of ventricular dyssynchrony may differ in children and those with congenital heart disease than in adults with structurally normal hearts, His-bundle pacing may also be a preferred option in these groups to restore more physiologic electric conduction and improve ventricular function. We present a review of the current literature and suggested directions involving deploying permanent His-bundle pacing in the pediatric and congenital heart disease population.
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Affiliation(s)
- Shannon Lyon
- Department of Pediatrics, Division of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gopi Dandamudi
- Cardiovascular Service Line, CHI Franciscan, Tacoma, WA, USA
| | - Adam C Kean
- Pediatric Electrophysiology, Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Calle S, Delens C, Kamoen V, De Pooter J, Timmermans F. Septal flash: At the heart of cardiac dyssynchrony. Trends Cardiovasc Med 2020; 30:115-122. [DOI: 10.1016/j.tcm.2019.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/31/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
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9
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Aalen JM, Remme EW, Larsen CK, Andersen OS, Krogh M, Duchenne J, Hopp E, Ross S, Beela AS, Kongsgaard E, Bergsland J, Odland HH, Skulstad H, Opdahl A, Voigt JU, Smiseth OA. Mechanism of Abnormal Septal Motion in Left Bundle Branch Block. JACC Cardiovasc Imaging 2019; 12:2402-2413. [DOI: 10.1016/j.jcmg.2018.11.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 12/28/2022]
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Miyazaki C. Left Atrial Dyssynchrony in Dilated Cardiomyopathy: Diastolic Dysfunction Matters but Left Bundle Branch Block Does Not. INTERNATIONAL JOURNAL OF HEART FAILURE 2019; 1:53-56. [PMID: 36262738 PMCID: PMC9536675 DOI: 10.36628/ijhf.2019.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Chinami Miyazaki
- Department of Cardiovascular Medicine, Higashisumiyoshi Morimoto Hospital, Osaka, Japan
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11
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Yaman B, Kemal HS, Dönmez Y, Cerit L, Usalp S, Yüksek Ü, Günsel A, Duygu H, Akpınar O. Improvement of abnormal systolic motion of the interventricular septum with cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1213-1218. [PMID: 31390077 DOI: 10.1111/pace.13772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/18/2019] [Accepted: 08/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is no consensus in the literature regarding what is the responsible mechanism of left ventricular dyssynchrony; septal dyskinesia or late movement of left ventricle (LV) lateral wall. We aim to evaluate the abnormal systolic motion in each myocardial segment and the improvement of LV systolic function with pulsed tissue Doppler imaging (TDI) in patients undergoing cardiac resynchronization therapy (CRT) with left bundle branch block (LBBB). METHODS A total of 26 patients undergoing CRT implantation with LBBB, wide QRS duration (≥120 ms), and low ejection fraction (EF) (<35%) were included. Pulsed TDI was taken from apical 4-chamber view and parasternal short axis view (PSAX). All echocardiographic parameters were measured when CRT is on and off. RESULTS Systolic ejection time (ET) of anteroseptal and posterolateral wall of LV in PSAX was statistically significantly longer in CRT on group (321.6 ± 62.7 vs 237.5 ± 59.3 ms, P < .001; 323.9 ± 58.0 vs 289.4 ± 43.7 ms, P = .015, respectively). In apical 4-chamber view, septal annulus systolic ET is significantly longer in CRT on group than CRT off group (315.8 ± 57.2 vs 287.3 ± 42.2, P = .014). Also, there was a strong correlation between systolic ET of the septum in PSAX with aortic velocity time integral (VTI), QRS duration and EF (r = .587, P = .002; r = .479, P = .013; r = .440, P = .025; respectively). CONCLUSION Circumferential contraction of septal myocardial fibers is improved with CRT and it is strongly correlated with increase of aortic VTI and shortening of QRS duration. These findings predict the deterioration of septal contraction as the main mechanism in patients with LBBB pattern and, CRT may improves myocardial contraction by correcting septal systolic motion.
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Affiliation(s)
- Belma Yaman
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Hatice S Kemal
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Yurdaer Dönmez
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Levent Cerit
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Songül Usalp
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Ümit Yüksek
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Aziz Günsel
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Hamza Duygu
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Onur Akpınar
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
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Zanon F, Abdelrahman M, Marcantoni L, Naperkowski A, Subzposh FA, Pastore G, Baracca E, Boaretto G, Raffagnato P, Tiribello A, Dandamudi G, Vijayaraman P. Long term performance and safety of His bundle pacing: A multicenter experience. J Cardiovasc Electrophysiol 2019; 30:1594-1601. [DOI: 10.1111/jce.14063] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Francesco Zanon
- Cardiology Department, Arrhythmia and Electrophysiology UnitSanta Maria Della Misericordia Hospital Rovigo Italy
| | - Mohamed Abdelrahman
- Department of Cardiac ElectrophysiologyGeisinger Heart Institute Wilkes‐Barre Pennsylvania
| | - Lina Marcantoni
- Cardiology Department, Arrhythmia and Electrophysiology UnitSanta Maria Della Misericordia Hospital Rovigo Italy
| | - Angela Naperkowski
- Department of Cardiac ElectrophysiologyGeisinger Heart Institute Wilkes‐Barre Pennsylvania
| | - Faiz A Subzposh
- Department of Cardiac ElectrophysiologyGeisinger Heart Institute Wilkes‐Barre Pennsylvania
| | - Gianni Pastore
- Cardiology Department, Arrhythmia and Electrophysiology UnitSanta Maria Della Misericordia Hospital Rovigo Italy
| | - Enrico Baracca
- Cardiology Department, Arrhythmia and Electrophysiology UnitSanta Maria Della Misericordia Hospital Rovigo Italy
| | - Graziano Boaretto
- Cardiology Department, Arrhythmia and Electrophysiology UnitSanta Maria Della Misericordia Hospital Rovigo Italy
| | - Paola Raffagnato
- Cardiology Department, Arrhythmia and Electrophysiology UnitSanta Maria Della Misericordia Hospital Rovigo Italy
| | - Antonella Tiribello
- Cardiology Department, Arrhythmia and Electrophysiology UnitSanta Maria Della Misericordia Hospital Rovigo Italy
| | - Gopi Dandamudi
- Department of Cardiac ElectrophysiologyGeisinger Heart Institute Wilkes‐Barre Pennsylvania
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Editorial commentary: Septal flash - what is behind the flashy name? Trends Cardiovasc Med 2019; 30:123-124. [PMID: 31010721 DOI: 10.1016/j.tcm.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/24/2022]
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Chávez-González E, Barja LD, Ortega DF, Pérez-Rodríguez A. Estimulación eléctrica permanente en región septal en pacientes con insuficiencia cardíaca secundaria a estimulación en ápex de ventrículo derecho. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:474-482. [DOI: 10.1016/j.acmx.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 11/26/2022] Open
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Clancy DJ, Mclean A, Slama M, Orde SR. Paradoxical septal motion: A diagnostic approach and clinical relevance. Australas J Ultrasound Med 2018; 21:79-86. [PMID: 34760507 DOI: 10.1002/ajum.12086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abnormal septal motion (commonly referred to as septal bounce) is a common echocardiographic finding that occurs with several conditions, including the following: mitral stenosis, left bundle branch block, pericardial syndromes and severe pulmonary hypertension. We explore the subtle changes that occur on M-mode imaging of the septum, other associated echocardiographic features, the impact of inspiratory effort on septal motion and relevant clinical findings. Finally, we discuss the impact of abnormal septal motion on cardiac form and function, proposing there is a clinically significant impact on biventricular filling and ejection.
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Affiliation(s)
- David J Clancy
- Intensive Care Unit Nepean Hospital Kingswood Sydney 2747 New South Wales Australia
| | - Anthony Mclean
- Intensive Care Unit Nepean Hospital Kingswood Sydney 2747 New South Wales Australia
| | - Michel Slama
- Intensive Care Unit Nepean Hospital Kingswood Sydney 2747 New South Wales Australia
| | - Sam R Orde
- Intensive Care Unit Nepean Hospital Kingswood Sydney 2747 New South Wales Australia
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Walmsley J, van Everdingen W, Cramer MJ, Prinzen FW, Delhaas T, Lumens J. Combining computer modelling and cardiac imaging to understand right ventricular pump function. Cardiovasc Res 2017; 113:1486-1498. [DOI: 10.1093/cvr/cvx154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/08/2017] [Indexed: 11/13/2022] Open
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17
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Mada RO, Lysyansky P, Duchenne J, Beyer R, Mada C, Muresan L, Rosianu H, Serban A, Winter S, Fehske W, Stankovic I, Voigt JU. New Automatic Tools to Identify Responders to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2016; 29:966-972. [DOI: 10.1016/j.echo.2016.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 10/21/2022]
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18
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Cardiovascular magnetic resonance features of mechanical dyssynchrony in patients with left bundle branch block. Int J Cardiovasc Imaging 2016; 32:1427-1438. [PMID: 27306621 DOI: 10.1007/s10554-016-0925-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Patients with left bundle branch block (LBBB) can exhibit mechanical dyssynchrony which may contribute to heart failure; such patients may benefit from cardiac resynchronization treatment (CRT). While cardiac magnetic resonance imaging (CMR) has become a common part of heart failure work-up, CMR features of mechanical dyssynchrony in patients with LBBB have not been well characterized. This study aims to investigate the potential of CMR to characterize mechanical features of LBBB. CMR examinations from 43 patients with LBBB on their electrocardiogram, but without significant focal structural abnormalities, and from 43 age- and gender-matched normal controls were retrospectively reviewed. The following mechanical features of LBBB were evaluated: septal flash (SF), apical rocking (AR), delayed aortic valve opening measured relative to both end-diastole (AVOED) and pulmonic valve opening (AVOPVO), delayed left-ventricular (LV) free-wall contraction, and curvatures of the septum and LV free-wall. Septal displacement curves were also generated, using feature-tracking techniques. The echocardiographic findings of LBBB were also reviewed in those subjects for whom they were available. LBBB was significantly associated with the presence of SF and AR; within the LBBB group, 79 % had SF and 65 % had AR. Delayed AVOED, AVOPVO, and delayed LV free-wall contraction were significantly associated with LBBB. AVOED and AVOPVO positively correlated with QRS duration and negatively correlated with ejection fraction. Hearts with electrocardiographic evidence of LBBB showed lower septal-to-LV free-wall curvature ratios at end-diastole compared to normal controls. CMR can be used to identify and evaluate mechanical dyssynchrony in patients with LBBB. None of the normal controls showed the mechanical features associated with LBBB. Moreover, not all patients with LBBB showed the same degree of mechanical dyssynchrony, which could have implications for CRT.
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Pinsky MR, Kim HK, Zenker S, Johnson L, Shroff S. Differential Effects of Left Ventricular Pacing Sites on Regional Contraction Patterns and Global Performance. J Cardiothorac Vasc Anesth 2016; 30:709-15. [PMID: 27321793 PMCID: PMC4916392 DOI: 10.1053/j.jvca.2016.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To define the differential effect of site-specific ventricular counterpacing efficacy during cardiac resynchronization therapy (CRT) to identify the most informative imaging views to quantify it. Cross-sectional and long-axis views commonly are used to assess left ventricular (LV) contractility. DESIGN The effects of LV apical (LVa) and free-wall (LVfw) pacing during CRT on long- and short-axis contraction, cardiac output, and stroke work were assessed in an open-chested acute canine model to determine whether LVa and LVfw would induce earlier apical than basilar LV radial contraction and earlier free-wall than septal contraction, respectively. Apical (CRTa) and free-wall (CRTfw) using right ventricular (RV) pacing-induced dyssynchrony also were examined. SETTING University large animal research laboratory. PARTICIPANTS Ten acutely anesthetized and instrumented open-chested purpose-bred dogs. INTERVENTIONS RV pacing served as the model of cardiac dyssynchrony. Selective LVfw and LVa pacing alone or with RV (CRTfw and CRTa, respectively) were studied relative to right atrial pacing (RA) as the control. MEASUREMENTS AND MAIN RESULTS Two pairs of 3 ultrasonic crystals were place along the LV longitudinal axis-apex and mid-to-base pairs along septal and free wall lines. Conductance catheter-defined longitudinal LV segmental volumes and pressure-volume data were collected. RV decreased cardiac output and stroke work compared with RA (2.0±0.3 v 1.4±0.1 L/min; 137±22 v 60±14 mJ; p<0.05, respectively). LVfw but not LVa decreased stroke work (130±35 mJ), and CRTa but not CRTfw improved both (2.1±0.2 L/min; 113±13 mJ; p<0.01 v RV pacing). No difference in time to minimal length free wall-to-septal crystal was seen with pacing. Both LVa and CRTa displayed increased apical-to-basilar shortening delay compared with RA, RV, and LVfw (42±47, 9±105, and 1±46 msec, respectively; p<0.05). No matching regional LV volume changes were seen during LVa. CONCLUSIONS LV functional analysis from only a cross-sectional plane may be insufficient to characterize improved LV contraction synchrony during multisite CRT.
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Affiliation(s)
- Michael R Pinsky
- Cardiopulmonary Research Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Hyung Kook Kim
- Cardiopulmonary Research Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Sven Zenker
- Cardiopulmonary Research Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
| | - Lauren Johnson
- Cardiovascular Systems Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Sanjeev Shroff
- Cardiovascular Systems Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
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20
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Gürel E, Prinz C, Van Casteren L, Gao H, Willems R, Voigt JU. The Impact of Function-Flow Interaction on Left Ventricular Efficiency in Patients with Conduction Abnormalities: A Particle Image Velocimetry and Tissue Doppler Study. J Am Soc Echocardiogr 2016; 29:431-40. [DOI: 10.1016/j.echo.2016.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Indexed: 10/22/2022]
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21
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Walmsley J, Huntjens PR, Prinzen FW, Delhaas T, Lumens J. Septal flash and septal rebound stretch have different underlying mechanisms. Am J Physiol Heart Circ Physiol 2016; 310:H394-403. [DOI: 10.1152/ajpheart.00639.2015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022]
Abstract
Abnormal left-right motion of the interventricular septum in early systole, known as septal flash (SF), is frequently observed in patients with left bundle branch block (LBBB). Transseptal pressure gradient and early active septal contraction have been proposed as explanations for SF. Similarities in timing (early systole) and location (septum) suggest that SF may be related to septal systolic rebound stretch (SRSsept). We aimed to clarify the mechanisms generating SF and SRSsept. The CircAdapt computer model was used to isolate the effects of timing of activation of the left ventricular free wall (LVFW), right ventricular free wall (RVFW), and septum on SF and SRSsept. LVFW and septal activation times were varied by ±80 ms relative to RVFW activation time. M-mode-derived wall motions and septal strains were computed and used to quantify SF and SRSsept, respectively. SF depended on early activation of the RVFW relative to the LVFW. SF and SRSsept occurred in LBBB-like simulations and against a rising transseptal pressure gradient. When the septum was activated before both LVFW and RVFW, no SF occurred despite the presence of SRSsept. Computer simulations therefore indicate that SF and SRSsept have different underlying mechanisms, even though both can occur in LBBB. The mechanism of leftward motion during SF is early RVFW contraction pulling on and straightening the septum when unopposed by the LVFW. SRSsept is caused by late LVFW contraction following early contraction of the septum. Changes in transseptal pressure gradient are not the main cause of SF in LBBB.
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Affiliation(s)
- John Walmsley
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
| | - Peter R. Huntjens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
- L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Université de Bordeaux, Pessac, France
| | - Frits W. Prinzen
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; and
- L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Université de Bordeaux, Pessac, France
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22
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Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16:233-70. [PMID: 25712077 DOI: 10.1093/ehjci/jev014] [Citation(s) in RCA: 4969] [Impact Index Per Article: 552.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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Affiliation(s)
- Roberto M Lang
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Luigi P Badano
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Victor Mor-Avi
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Jonathan Afilalo
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Anderson Armstrong
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Laura Ernande
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Frank A Flachskampf
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Elyse Foster
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Steven A Goldstein
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Tatiana Kuznetsova
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Patrizio Lancellotti
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Denisa Muraru
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Michael H Picard
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Ernst R Rietzschel
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Lawrence Rudski
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Kirk T Spencer
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Wendy Tsang
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Jens-Uwe Voigt
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
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23
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Remme EW, Niederer S, Gjesdal O, Russell K, Hyde ER, Smith N, Smiseth OA. Factors determining the magnitude of the pre-ejection leftward septal motion in left bundle branch block. Europace 2015; 18:1905-1913. [PMID: 26612883 PMCID: PMC5291191 DOI: 10.1093/europace/euv381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/21/2015] [Indexed: 11/13/2022] Open
Abstract
Aims An abnormal large leftward septal motion prior to ejection is frequently observed in left bundle branch block (LBBB) patients. This motion has been proposed as a predictor of response to cardiac resynchronization therapy (CRT). Our goal was to investigate factors that influence its magnitude. Methods and results Left (LVP) and right ventricular (RVP) pressures and left ventricular (LV) volume were measured in eight canines. After induction of LBBB, LVP and, hence, the transmural septal pressure (PLV–RV = LVP–RVP) increased more slowly (P < 0.01) during the phase when septum moved leftwards. A biventricular finite-element LBBB simulation model confirmed that the magnitude of septal leftward motion depended on reduced rise of PLV–RV. The model showed that leftward septal motion was decreased with shorter activation delay, reduced global or right ventricular (RV) contractility, septal infarction, or when the septum was already displaced into the LV at end diastole by RV volume overload. Both experiments and simulations showed that pre-ejection septal hypercontraction occurs, in part, because the septum performs more of the work pushing blood towards the mitral valve leaflets to close them as the normal lateral wall contribution to this push is lost. Conclusions Left bundle branch block lowers afterload against pre-ejection septal contraction, expressed as slowed rise of PLV–RV, which is a main cause and determinant of the magnitude of leftward septal motion. The motion may be small or absent due to septal infarct, impaired global or RV contractility or RV volume overload, which should be kept in mind if this motion is to be used in evaluation of CRT response.
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Affiliation(s)
- Espen W Remme
- Institute for Surgical Research, Oslo University Hospital, 0372 Oslo, Norway .,Centre for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway.,KG Jebsen Cardiac Research Centre, University of Oslo, Oslo, Norway
| | - Steven Niederer
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Ola Gjesdal
- Institute for Surgical Research, Oslo University Hospital, 0372 Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kristoffer Russell
- Institute for Surgical Research, Oslo University Hospital, 0372 Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Eoin R Hyde
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Nicolas Smith
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital, 0372 Oslo, Norway.,Centre for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway.,KG Jebsen Cardiac Research Centre, University of Oslo, Oslo, Norway
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24
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Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1-39.e14. [PMID: 25559473 DOI: 10.1016/j.echo.2014.10.003] [Citation(s) in RCA: 8368] [Impact Index Per Article: 929.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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Affiliation(s)
| | | | | | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Laura Ernande
- INSERM U955 and Hôpital Henri Mondor, Créteil, France
| | | | - Elyse Foster
- University of California, San Francisco, California
| | | | | | | | | | - Michael H Picard
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Lawrence Rudski
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Wendy Tsang
- University of Toronto, Toronto, Ontario, Canada
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25
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Effect of pacemaker site on B-type natriuretic peptide levels and left ventricular function in a population with high prevalence of Chagas disease. Int J Cardiol 2015; 190:315-8. [DOI: 10.1016/j.ijcard.2015.04.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 11/23/2022]
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26
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Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm 2015; 12:305-12. [DOI: 10.1016/j.hrthm.2014.10.021] [Citation(s) in RCA: 267] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Indexed: 11/20/2022]
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27
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VIJAYARAMAN PUGAZHENDHI, DANDAMUDI GOPI, WORSNICK SARAH, ELLENBOGEN KENNETHA. Acute His-Bundle Injury Current during Permanent His-Bundle Pacing Predicts Excellent Pacing Outcomes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:540-6. [DOI: 10.1111/pace.12571] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- PUGAZHENDHI VIJAYARAMAN
- Department of Cardiac Electrophysiology; Geisinger Heart and Vascular Institute; Wilkes-Barre Pennsylvania
| | - GOPI DANDAMUDI
- Department of Cardiac Electrophysiology; Geisinger Heart and Vascular Institute; Wilkes-Barre Pennsylvania
| | - SARAH WORSNICK
- Department of Cardiac Electrophysiology; Geisinger Heart and Vascular Institute; Wilkes-Barre Pennsylvania
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28
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Left bundle branch block and echocardiography in the era of CRT. J Echocardiogr 2014; 13:6-14. [DOI: 10.1007/s12574-014-0233-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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29
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Flail septal leaflet of the tricuspid valve due to rupture of chordae tendineae ten years after pacemaker implantation. Int J Cardiol 2014; 176:e41-6. [DOI: 10.1016/j.ijcard.2014.07.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 07/05/2014] [Indexed: 11/17/2022]
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30
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Brunet-Bernard A, Maréchaux S, Fauchier L, Guiot A, Fournet M, Reynaud A, Schnell F, Leclercq C, Mabo P, Donal E. Combined score using clinical, electrocardiographic, and echocardiographic parameters to predict left ventricular remodeling in patients having had cardiac resynchronization therapy six months earlier. Am J Cardiol 2014; 113:2045-51. [PMID: 24793667 DOI: 10.1016/j.amjcard.2014.03.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate whether a scoring system integrating clinical, electrocardiographic, and echocardiographic measurements can predict left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). The derivation cohort consisted of 162 patients with heart failure implanted with a CRT device. Baseline clinical, electrocardiographic, and echocardiographic characteristics were entered into univariate and multivariate models to predict reverse remodeling as defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months (60%). Combinations of predictors were then tested under different scoring systems. A new 7-point CRT response score termed L2ANDS2: Left bundle branch block (2 points), Age >70 years, Nonischemic origin, left ventricular end-diastolic Diameter <40 mm/m(2), and Septal flash (2 points) was calculated for these patients. This score was then validated against a validation cohort of 45 patients from another academic center. A highly significant incremental predictive value was noted when septal flash was added to an initial 4-factor model including left bundle branch block (difference between area under the curve C statistics = 0.125, p <0.001). The predictive accuracy using the L2ANDS2 score was then 0.79 for the C statistic. Application of the new score to the validation cohort (71% of responders) gave a similar C statistic (0.75). A score >5 had a high positive likelihood ratio (+LR = 5.64), whereas a score <2 had a high negative likelihood ratio (-LR = 0.19). In conclusion, this L2ANDS2 score provides an easy-to-use tool for the clinician to assess the pretest probability of a patient being a CRT responder.
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Affiliation(s)
- Anne Brunet-Bernard
- CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; INSERM, U1099, Rennes, France; Université Rennes 1, LTSI, Rennes, France; Université François Rabelais, Tours, France; Service de Cardiologie, Centre Hospitalier Universitaire Tours, France
| | - Sylvestre Maréchaux
- Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Université Catholique de Lille, Lille, France; INSERM, U1088, Université de Picardie, Amiens, France
| | - Laurent Fauchier
- Université François Rabelais, Tours, France; Service de Cardiologie, Centre Hospitalier Universitaire Tours, France
| | - Aurélie Guiot
- Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Université Catholique de Lille, Lille, France
| | - Maxime Fournet
- CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; Université Rennes 1, LTSI, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire Rennes, France
| | - Amélie Reynaud
- CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; INSERM, U1099, Rennes, France; Université Rennes 1, LTSI, Rennes, France
| | - Frédéric Schnell
- CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; INSERM, U1099, Rennes, France; Université Rennes 1, LTSI, Rennes, France
| | - Christophe Leclercq
- CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; Université Rennes 1, LTSI, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire Rennes, France
| | - Philippe Mabo
- CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; Université Rennes 1, LTSI, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire Rennes, France
| | - Erwan Donal
- CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; Université Rennes 1, LTSI, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire Rennes, France.
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Sohal M, Amraoui S, Chen Z, Sammut E, Jackson T, Wright M, O’Neill M, Gill J, Carr-White G, Rinaldi CA, Razavi R. Combined identification of septal flash and absence of myocardial scar by cardiac magnetic resonance imaging improves prediction of response to cardiac resynchronization therapy. J Interv Card Electrophysiol 2014; 40:179-90. [DOI: 10.1007/s10840-014-9907-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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32
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Myocardial motion and deformation patterns in an experimental swine model of acute LBBB/CRT and chronic infarct. Int J Cardiovasc Imaging 2014; 30:875-87. [DOI: 10.1007/s10554-014-0403-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
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33
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Sakamaki F, Seo Y, Atsumi A, Yamamoto M, Machino-Ohtsuka T, Kawamura R, Yamasaki H, Igarashi M, Sekiguchi Y, Ishizu T, Aonuma K. Novel dyssynchrony evaluation by M-mode imaging in left bundle branch block and the application to predict responses for cardiac resynchronization therapy. J Cardiol 2014; 64:199-206. [PMID: 24582308 DOI: 10.1016/j.jjcc.2013.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/24/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND To determine an appropriate M-mode method in assessing left ventricular (LV) dyssynchrony in left bundle branch block (LBBB), and to assess feasibility of the method to predict cardiac resynchronization therapy (CRT) responses. METHODS AND RESULTS Fifty-one patients with LBBB were enrolled. Among them 31 patients underwent CRT. In addition to original septal to posterior wall motion delay (SPWMD), first peak-SPWMD was proposed as time of difference between the first septal displacement and the maximum displacement of the posterior. If an early septal point was not present, anatomical M-mode was used to visualize an early septal displacement spreading scan-area until inferoseptal wall. CRT responders were defined as LV end-systolic volume reduction (>15%) at 6 months after CRT. Twenty patients (65%) were identified as CRT responders. First peak-SPWMD in responders was significantly higher than those in nonresponders, although SPWMD did not differ between groups. Strong predicting ability of first peak-SPWMD was revealed (first peak-SPWMD: 80/90/83%; SPWMD: 35/100/58%), and area under the curve in receiver operating characteristic analysis of first peak-SPWMD (0.88) was significantly higher than that of SPWMD (0.61) (p<0.05). CONCLUSION In patients with LBBB, time differences between early septal and delayed displacement of posterolateral wall on M-mode images were the appropriate dyssynchrony parameter, and could improve the predictive ability for CRT responses.
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Affiliation(s)
- Fumiko Sakamaki
- Department of Clinical Laboratory, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Akiko Atsumi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayoshi Yamamoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Ryo Kawamura
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiro Yamasaki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Miyako Igarashi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Ortega MC, Morejón AEG, Ricardo GS. Left ventricular synchrony and function in pediatric patients with definitive pacemakers. Arq Bras Cardiol 2013; 101:410-7. [PMID: 24061683 PMCID: PMC4081164 DOI: 10.5935/abc.20130189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 11/19/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Chronic right ventricular pacing (RVP) induces a dyssynchronous contraction pattern,producing interventricular and intraventricular asynchrony. Many studies have shown the relationship of RVP with impaired left ventricular (LV) form and function. OBJECTIVE The aim of this study was to evaluate LV synchrony and function in pediatric patients receiving RVP in comparison with those receiving LV pacing (LVP). METHODS LV systolic and diastolic function and synchrony were evaluated in 80 pediatric patients with either nonsurgical or postsurgical complete atrioventricular block, with pacing from either the RV endocardium (n = 40) or the LV epicardium (n = 40). Echocardiographic data obtained before pacemaker implantation, immediately after it, and at the end of a mean follow-up of 6.8 years were analyzed. RESULTS LV diastolic function did not change in any patient during follow-up. LV systolic function was preserved in patients with LVP. However, in children with RVP the shortening fraction and ejection fraction decreased from medians of 41% ± 2.6% and 70% ± 6.9% before implantation to 32% ± 4.2% and 64% ± 2.5% (p < 0.0001 and p < 0.0001), respectively, at final follow-up. Interventricular mechanical delay was significantly larger with RVP (66 ± 13 ms) than with LVP (20 ± 8 ms). Similarly, the following parameters were significantly different in the two groups: LV mechanical delay (RVP: 69 ± 6 ms, LVP: 30 ± 11 ms, p < 0.0001); septal to lateral wall motion delay (RVP: 75 ± 19 ms, LVP: 42 ± 10 ms, p < 0.0001); and, septal to posterior wall motion delay (RVP: 127 ± 33 ms, LVP: 58 ± 17 ms, p < 0.0001). CONCLUSION Compared with RV endocardium, LV epicardium is an optimal site for pacing to preserve cardiac synchrony and function.
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Affiliation(s)
- Michel Cabrera Ortega
- Departamento de Arritmia e Estimulação Cardíaca - Cardiocentro
Pediátrico ¨William Soler¨, Havana, Cuba
- Mailing Address: Michel Cabrera Ortega, 100 y Perla, Altahabana, Boyeros
10800, Havana, Cuba. E-mail:
| | | | - Giselle Serrano Ricardo
- Havana, Cuba; Departamento de Ecocardiografia - Cardiocentro Pediátrico
¨William Soler¨, Havana, Cuba
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Sullivan B, Puskas F, Fernandez-Bustamante A. Transesophageal echocardiography in noncardiac thoracic surgery. Anesthesiol Clin 2013; 30:657-69. [PMID: 23089501 DOI: 10.1016/j.anclin.2012.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In high-risk surgeries with medically complicated patients, transesophageal echocardiography (TEE) adds an additional level of monitoring with which few can disagree. This article presents multiple applications of TEE that can assist both the anesthesiologist and the surgeon through major noncardiac thoracic surgery. It highlights how TEE can be used as an adjuvant to lung resection surgery; TEE as a monitor during lung transplantation; TEE to assess patients for extracorporeal membrane oxygenation; TEE for thoracic aortic surgery; and TEE in the assessment of patients with acute pulmonary hypertension undergoing noncardiac thoracic surgery.
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Affiliation(s)
- Breandan Sullivan
- Department of Anesthesiology and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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Duchateau N, Doltra A, Silva E, De Craene M, Piella G, Castel MÁ, Mont L, Brugada J, Frangi AF, Sitges M. Atlas-based quantification of myocardial motion abnormalities: added-value for understanding the effect of cardiac resynchronization therapy. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:2186-2197. [PMID: 23069133 DOI: 10.1016/j.ultrasmedbio.2012.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 07/27/2012] [Accepted: 08/11/2012] [Indexed: 06/01/2023]
Abstract
Statistical atlases may help improving the analysis of cardiac wall-motion abnormalities. This study aims at demonstrating the clinical value of such a method to better understand the effect of cardiac resynchronization therapy (CRT). We compared an atlas of normal septal motion built using apical four-chamber two-dimensional echocardiographic sequences from healthy volunteers with 88 patients undergoing CRT at baseline and at 12 months follow-up. Abnormal motion was quantified locally using a p value based on a statistical distance to normality. Reduction ≥15% in left ventricle end-systolic volume defined CRT response. Responders showed significantly higher reduction of abnormalities (p ≤ 0.001). Non-responders conserved abnormal septal motion at the end of the isovolumic contraction (IVC). A specific inward-outward motion of the septum during IVC predominated in responders and was corrected at follow-up. The method is of interest to characterize patterns of mechanical dyssynchrony and to study the link between their evolution and CRT response.
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Affiliation(s)
- Nicolas Duchateau
- Center for Computational Imaging and Simulation Technologies in Biomedicina, Universitat Pompeu Fabra and Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain.
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Chatterjee NA, Upadhyay GA, Ellenbogen KA, Hayes DL, Singh JP. Atrioventricular nodal ablation in atrial fibrillation: a meta-analysis of biventricular vs. right ventricular pacing mode. Eur J Heart Fail 2012; 14:661-7. [PMID: 22436544 DOI: 10.1093/eurjhf/hfs036] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIMS For patients with refractory atrial fibrillation (AF) undergoing atrioventricular nodal ablation (AVNA), initial single-chamber right ventricular (RV)-only pacing is standard. Given the deleterious effects of chronic RV-only pacing, the impact of an initial biventricular (BiV) pacing strategy post-ablation is of interest. METHODS AND RESULTS We conducted a meta-analysis to determine the effect of BiV vs. RV-only pacing in patients undergoing AVNA for refractory atrial fibrillation. A search of multiple electronic databases identified 921 reports, which included four randomized controlled trials (n = 534). Mean New York Heart Association (NYHA) class was 2.3 and mean left ventricular ejection fraction (LVEF) was 44%. When compared with RV-only pacing, BiV pacing was not associated with reduced mortality [risk ratio 0.85, 95% confidence interval (CI) 0.40-1.82, P = 0.68]. In three studies comprised of patients with left ventricular systolic dysfunction (mean EF 41 ± 3%), BiV pacing demonstrated a non-significant reduction in cardiac mortality (risk ratio 0.59, 95% CI 0.25-1.39; P = 0.23). Compared with RV-only pacing, BiV pacing was associated with significant improvement in symptoms [Minnesota Living with Heart Failure Questionnaire (MLWHFQ) 2.72 points fewer, 95% CI 1.45-3.99] and increased LVEF (+2.6%, 95% CI 1.69-3.44), but no significant change in 6 min walk distance (6MWD) (5.02 ms more, 95% CI -1.56 to 11.59; P = 0.13). CONCLUSIONS In patients with refractory AF undergoing AVNA, BiV pacing was not associated with significantly improved survival when compared with RV-only pacing. A modest, but significant improvement in structural and functional response to BiV pacing was observed.
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Affiliation(s)
- Neal A Chatterjee
- Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA 02411, USA
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Sakamaki F, Seo Y, Ishizu T, Yanaka S, Atsumi A, Yamamoto M, Machino-Ohtsuka T, Kawamura R, Yamasaki H, Igarashi M, Yoshida K, Sekiguchi Y, Tada H, Aonuma K. Tissue Doppler Imaging Dyssynchrony Parameter Derived From the Myocardial Active Wall Motion Improves Prediction of Responders for Cardiac Resynchronization Therapy. Circ J 2012; 76:689-97. [DOI: 10.1253/circj.cj-11-0774] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fumiko Sakamaki
- Department of Clinical Laboratory, Tsukuba University Hospital
| | - Yoshihiro Seo
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Tomoko Ishizu
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Satomi Yanaka
- Department of Clinical Laboratory, Tsukuba University Hospital
| | - Akiko Atsumi
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Masayoshi Yamamoto
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Tomoko Machino-Ohtsuka
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Ryo Kawamura
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Hiro Yamasaki
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Miyako Igarashi
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Kentaro Yoshida
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Yukio Sekiguchi
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Hiroshi Tada
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Kazutaka Aonuma
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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van Geldorp IE, Vanagt WY, Prinzen FW, Delhaas T. Chronic ventricular pacing in children: toward prevention of pacing-induced heart disease. Heart Fail Rev 2011; 16:305-14. [PMID: 21107685 PMCID: PMC3074059 DOI: 10.1007/s10741-010-9207-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In children with congenital or acquired complete atrioventricular (AV) block, ventricular pacing is indicated to increase heart rate. Ventricular pacing is highly beneficial in these patients, but an important side effect is that it induces abnormal electrical activation patterns. Traditionally, ventricular pacemaker leads are positioned at the right ventricle (RV). The dyssynchronous pattern of ventricular activation due to RV pacing is associated with an acute and chronic impairment of left ventricular (LV) function, structural remodeling of the LV, and increased risk of heart failure. Since the degree of pacing-induced dyssynchrony varies between the different pacing sites, ‘optimal-site pacing’ should aim at the prevention of mechanical dyssynchrony. Especially in children, generally paced from a very early age and having a perspective of life-long pacing, the preservation of cardiac function during chronic ventricular pacing should take high priority. In the perspective of the (patho)physiology of ventricular pacing and the importance of the sequence of activation, this paper provides an overview of the current knowledge regarding possible alternative sites for chronic ventricular pacing. Furthermore, clinical implications and practical concerns of the various pacing sites are discussed. The review concludes with recommendations for optimal-site pacing in children.
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Affiliation(s)
- Irene E van Geldorp
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Echocardiographic prediction of outcome after cardiac resynchronization therapy: conventional methods and recent developments. Heart Fail Rev 2011; 16:235-50. [PMID: 21104122 PMCID: PMC3074077 DOI: 10.1007/s10741-010-9200-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Echocardiography plays an important role in patient assessment before cardiac resynchronization therapy (CRT) and can monitor many of its mechanical effects in heart failure patients. Encouraged by the highly variable individual response observed in the major CRT trials, echocardiography-based measurements of mechanical dyssynchrony have been extensively investigated with the aim of improving response prediction and CRT delivery. Despite recent setbacks, these techniques have continued to develop in order to overcome some of their initial flaws and limitations. This review discusses the concepts and rationale of the available echocardiographic techniques, highlighting newer quantification methods and discussing some of the unsolved issues that need to be addressed.
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De Boeck BWL, Teske AJ, Leenders GE, Mohamed Hoesein FAA, Loh P, van Driel VJ, Doevendans PA, Prinzen FW, Cramer MJ. Detection and quantification by deformation imaging of the functional impact of septal compared to free wall preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 2010; 106:539-546.e2. [PMID: 20691313 DOI: 10.1016/j.amjcard.2010.03.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 11/30/2022]
Abstract
Pacing experiments in healthy animal hearts have suggested a larger detrimental effect of septal compared to free wall preexcitation. We investigated the intrinsic relation among the site of electrical preexcitation, mechanical dyssynchrony, and dysfunction in human patients. In 33 patients with Wolff-Parkinson-White (WPW) syndrome and 18 controls, regional myocardial deformation was assessed by speckle tracking mapping (ST-Map) to assess the preexcitation site, shortening sequences and dyssynchrony, and the extent of local and global ejecting shortening. The ST-Map data in patients with accessory atrioventricular pathways correctly diagnosed as located in the interventricular septum (IVS) (n = 11) or left ventricular free wall (LFW) (n = 12) were compared to the corresponding control values. A local ejecting shortening of <2 SD of the control values identified hypokinetic segments. The localization of the atrioventricular pathways by ST-Map matched with the invasive electrophysiology findings in 23 of 33 patients and was one segment different in 5 of 33 patients. In both WPW-IVS and WPW-LFW, local ejecting shortening was impaired at the preexcitation site (p <0.01). However, at similar electrical and mechanical dyssynchrony, WPW-IVS had more extensive hypokinesia than did WPW-LFW (3.6 +/- 0.9 vs 1.8 +/- 1.3 segments, p <0.01). Compared to controls, the left ventricular function was significantly reduced only in WPW-IVS (global ejecting shortening 17 +/- 2% vs 19 +/- 2%, p = 0.01; ejection fraction 55 +/- 5% vs 59 +/- 3%, p = 0.02). In conclusion, preexcitation is associated with local hypokinesia, which at comparable preexcitation is more extensive in WPW-IVS than in WPW-LFW and could adversely affect ventricular function. ST-Map might have a future role in detecting and guiding treatment of septal pathways with significant mechanical effects.
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Vaturi M, Kusniec J, Shapira Y, Nevzorov R, Yedidya I, Weisenberg D, Monakier D, Strasberg B, Sagie A. Right ventricular pacing increases tricuspid regurgitation grade regardless of the mechanical interference to the valve by the electrode. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:550-3. [DOI: 10.1093/ejechocard/jeq018] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lumens J, Delhaas T, Kirn B, Arts T. Three-wall segment (TriSeg) model describing mechanics and hemodynamics of ventricular interaction. Ann Biomed Eng 2009; 37:2234-55. [PMID: 19718527 PMCID: PMC2758607 DOI: 10.1007/s10439-009-9774-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 07/30/2009] [Indexed: 11/28/2022]
Abstract
A mathematical model (TriSeg model) of ventricular mechanics incorporating mechanical interaction of the left and right ventricular free walls and the interventricular septum is presented. Global left and right ventricular pump mechanics were related to representative myofiber mechanics in the three ventricular walls, satisfying the principle of conservation of energy. The walls were mechanically coupled satisfying tensile force equilibrium in the junction. Wall sizes and masses were rendered by adaptation to normalize mechanical myofiber load to physiological standard levels. The TriSeg model was implemented in the previously published lumped closed-loop CircAdapt model of heart and circulation. Simulation results of cardiac mechanics and hemodynamics during normal ventricular loading, acute pulmonary hypertension, and chronic pulmonary hypertension (including load adaptation) agreed with clinical data as obtained in healthy volunteers and pulmonary hypertension patients. In chronic pulmonary hypertension, the model predicted right ventricular free wall hypertrophy, increased systolic pulmonary flow acceleration, and increased right ventricular isovolumic contraction and relaxation times. Furthermore, septal curvature decreased linearly with its transmural pressure difference. In conclusion, the TriSeg model enables realistic simulation of ventricular mechanics including interaction between left and right ventricular pump mechanics, dynamics of septal geometry, and myofiber mechanics in the three ventricular walls.
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Affiliation(s)
- Joost Lumens
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Septal rebound stretch reflects the functional substrate to cardiac resynchronization therapy and predicts volumetric and neurohormonal response. Eur J Heart Fail 2009; 11:863-71. [DOI: 10.1093/eurjhf/hfp107] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Seo Y, Ishizu T, Sakamaki F, Yamamoto M, Machino T, Watanabe S, Aonuma K. Analysis of the origin of cardiac wall motion that constitutes myocardial velocity-time curves in patients with left bundle branch block. J Am Soc Echocardiogr 2009; 22:331-6. [PMID: 19345303 DOI: 10.1016/j.echo.2009.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Indexed: 11/16/2022]
Abstract
Septal and lateral wall myocardial velocity-time curves from tissue Doppler imaging were analyzed to determine wall motion from which the velocity originated in 34 patients with left bundle branch and systolic dysfunction (ejection fraction < 45%). Longitudinal strain rate by speckle tracking imaging was assessed to identify whether corresponding wall motion was active or passive. All lateral peak velocities during the ejection period were derived from delayed active movement. However, septal peak velocities were more numerous and complex. Septal peak velocities during pre-ejection were derived from the first active movement in 29 patients (85.2%). Septal peak velocities during the ejection period were derived from the second active movement in 20 patients, passive movement in 9 patients, and first active movement in 5 patients. Because septal peak velocities were consistent with various wall motion types, identification of the origin of septal peak velocities, including during pre-ejection, may be important in identifying LV dyssynchrony based on the propagation of first active myocardial movements.
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Affiliation(s)
- Yoshihiro Seo
- Cardiovascular Division, Graduate School of Comprehensive Human Science, University of Tsukuba, Ibaraki, Japan.
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Kibler NA, Kharin SN, Tsvetkova AS, Azarov YE, Shmakov DN. Effect of ectopic excitation on pump function of the hen and dog right heart ventricle. J EVOL BIOCHEM PHYS+ 2009. [DOI: 10.1134/s0022093009010104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Maisenbacher HW, Estrada AH, Prosek R, Shih AC, Vangilder JM. Evaluation of the effects of transvenous pacing site on left ventricular function and synchrony in healthy anesthetized dogs. Am J Vet Res 2009; 70:455-63. [PMID: 19335100 DOI: 10.2460/ajvr.70.4.455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE-To compare the acute effects of cardiac pacing from various transvenous pacing sites on left ventricular (LV) function and synchrony in clinically normal dogs. ANIMALS-10 healthy adult mixed-breed dogs. PROCEDURES-Dogs were anesthetized, and dual-chamber transvenous biventricular pacing systems were implanted. Dogs were paced in single-chamber mode from the right atrial appendage (RAA) alone and in dual-chamber mode from the right ventricular apex (RVA), from the left ventricular free wall (LVFW), and simultaneously from the RVA and LVFW (BiV). Standard ECG and echocardiographic measurements, cardiac output measured with the lithium dilution method (LiDCO), and tissue Doppler-derived measurements of LV synchrony were obtained during each of the pacing configurations. RESULTS-Placement of the biventricular pacing systems was possible in 8 of the 10 dogs. The QRS duration was significantly different among all pacing sites, and the order of increasing duration was RAA, BiV, LVFW, and RVA. Pacing sites did not differ with respect to fractional shortening; however, pacing from the RVA resulted in a significantly lower ejection fraction than pacing from all other sites. During RVA and LVFW pacing, LiDCO was significantly lower than that at other sites; there was no significant difference between RAA and BiV pacing with respect to LiDCO. Although the degree of dyssynchrony was significantly lower during pacing from the RAA versus other ventricular pacing sites, it was not significantly different among sites. CONCLUSIONS AND CLINICAL RELEVANCE-Ventricular activation by RAA pacing provided the best LV function and synchrony. Pacing from the RVA worsened LV function, and although pacing from the LVFW improved it, BiV pacing may provide additional improvement.
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Affiliation(s)
- Herbert W Maisenbacher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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Johnson L, Simon MA, Pinsky MR, Shroff SG. Insights into the effects of contraction dyssynchrony on global left ventricular mechano-energetic function. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:224-33. [PMID: 19170912 DOI: 10.1111/j.1540-8159.2008.02206.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The effects of dyssynchrony on global left ventricular (LV) mechanics have been well documented; however, its impact on LV energetics has received less attention. OBJECTIVE To assess the effects of LV contraction dyssynchrony on global LV mechano-energetic function in a pacing-induced acute model of dyssynchrony. METHODS Using blood-perfused isolated rabbit heart preparations (n = 11), LV pressure, coronary flow, and arteriovenous oxygen content difference were recorded for isovolumic contractions under right atrial (RA) pacing (control) and simultaneous RA and right ventricular outflow tract (RVOT) pacing (dyssynchrony). LV mechanical function was quantified by the end-systolic pressure-volume relationship (ESPVR). Myocardial oxygen consumption-pressure-volume area (MVO(2)-PVA) relationship quantified LV energetic function. Internal PVA for MVO(2 RVOT) was calculated based on the MVO(2)-PVA relationship for RA pacing. Thus, lost PVA (internal PVA-PVA(RVOT)) represents the mechanical energy not observable at the global level. RESULTS Compared to RA pacing, RVOT pacing depressed LV mechanics as indicated by a rightward shift of ESPVR (i.e., increase in V(d) from 0.58 +/- 0.10 to 0.67 +/- 0.10 mL, P < 0.05). Despite depressed mechanics, RVOT pacing was associated with greater MVO(2) such that the MVO(2)-PVA relationship intercept was markedly increased from 0.025 +/- 0.003 to 0.029 +/- 0.003 mL*O(2)/beat/100gLV (P < 0.05). Excess MVO(2) (i.e., MVO(2 RVOT)- MVO(2 RA)) significantly correlated with lost PVA (R(2)= 0.54, P < 0.001). CONCLUSION A potential mechanism explaining the observed increase in MVO(2) with dyssynchrony may be that the measured PVA at the global level underestimates the internal PVA at the cellular level, which is likely to be the true determinant of MVO(2).
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Affiliation(s)
- Lauren Johnson
- Department of Bioengineering, Cardiovascular Systems Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Quantification of Improved Left Ventricular Performance during Cardiac Resynchronization Therapy. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_7] [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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Prinzen FW. Imaging or imagination of cardiac mechanics? ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:166-169. [PMID: 19963954 DOI: 10.1109/iembs.2009.5333353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ultrasound and MRI systems allow to measure many variables related to cardiac motion and deformation. These imaging modalities have the advantage to be non-invasive, thereby facilitating measurements in man. Many custom available parameters are, however, not useful for proper analysis of cardiac mechanics and can yield confusing results. This is especially relevant if important decisions for the patient have to be made and if complicated mechanical abnormalities are investigated, such as abnormal electrical activation of the ventricles. Recent developments in ultrasound technology and data analysis provide novel opportunities for better mechanical analysis and, presumably, better diagnosis.
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Affiliation(s)
- Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, 6200 MD Maastricht, The Netherlands.
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