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Wijesuriya N, Mehta V, De Vere F, Howell S, Mannakkara N, Sidhu B, Elliott M, Bosco P, Sanders P, Singh JP, Walsh MN, Niederer SA, Rinaldi CA. Left ventricular electrical delay predicts volumetric response to leadless cardiac resynchronization therapy. Heart Rhythm 2024:S1547-5271(24)03268-5. [PMID: 39209224 DOI: 10.1016/j.hrthm.2024.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/08/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Leadless left ventricular (LV) endocardial pacing is an emerging cardiac resynchronization therapy (CRT) technology. Predictors of response to leadless CRT are poorly understood. Implanting the LV endocardial pacing electrode in sites with increased electrical latency (Q-LV) may improve response rates. OBJECTIVE The purpose of this study was to examine the association between Q-LV and echocardiographic remodeling response to leadless CRT delivered with the WiSE-CRT system. METHODS A post hoc analysis (n = 122) of the SOLVE-CRT trial examined the relationship between LV pacing site Q-LV with rate of left ventricular end-systolic volume (LVESV) reduction >15% at 6 months. Multivariable regression analysis, adjusting for age, sex, previous CRT nonresponse, cardiomyopathy etiology, QRS morphology, and QRS duration was performed, followed by receiver operating characteristic analysis and analysis of variance by Q-LV quartile. A subgroup analysis of the ischemic cardiomyopathy cohort was undertaken. RESULTS Complete Q-LV data were available for 122 of 153 patients (80%) in the active arms SOLVE-CRT. Overall, the 6-month LVESV response rate was 46%. Logistic regression identified Q-LV as an independent response predictor with borderline significance (adjusted odds ratio 1.015; P = .05). Analysis by Q-LV quartile demonstrated a significant improvement in response rate in quartile 4 (longest Q-LV 64%) compared to quartile 1 (shortest Q-LV 28%) (P <.01). This association was primarily driven by strong Q-LV-response correlation in patients with ischemic cardiomyopathy, demonstrated by subgroup logistic regression (adjusted odds ratio 1.034; P = .004). CONCLUSION Increased Q-LV was associated with improved reverse remodeling following leadless CRT. Targeting LV endocardial sites of high Q-LV may deliver additional benefit compared to empirical LV electrode implantation.
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Affiliation(s)
- Nadeev Wijesuriya
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom.
| | - Vishal Mehta
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - Felicity De Vere
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - Sandra Howell
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - Nilanka Mannakkara
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | | | | | - Paolo Bosco
- Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Steven A Niederer
- King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Alan Turing Institute, London, United Kingdom
| | - Christopher A Rinaldi
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
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2
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Chen Z, Ma X, Wu S, Gao Y, Song Y, Lu M, Dai Y, Zhang S, Hua W, Gold MR, Zhao S, Chen K. A Comparison of the Association of Septal Scar Burden on Responses to LBBAP-CRT and BVP-CRT. JACC Clin Electrophysiol 2024; 10:1439-1451. [PMID: 38727661 DOI: 10.1016/j.jacep.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 07/26/2024]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). However, despite the presence of left bundle branch block, whether cardiac substrate may influence the effect between the 2 strategies is unclear. OBJECTIVES This study aims to assess the association of septal scar on reverse remodeling and clinical outcomes of LBBAP compared with BVP. METHODS We analyzed patients with nonischemic cardiomyopathy who had CRT indications undergoing preprocedure cardiac magnetic resonance examination. Changes in left ventricular ejection fraction (LVEF) and echocardiographic response (ER) (≥5% absolute LVEF increase) were assessed at 6 months. The clinical outcome was the composite of all-cause mortality, heart failure hospitalization, or major ventricular arrhythmia. RESULTS There were 147 patients included (51 LBBAP and 96 BVP). Among patients with low septal scar burden (below median 5.7%, range: 0% to 5.3%), LVEF improvement was higher in the LBBAP than the BVP group (17.5% ± 10.9% vs 12.3% ± 11.8%; P = 0.037), with more than 3-fold increased odds of ER (OR: 4.35; P = 0.033). In high sepal scar subgroups (≥5.7%, range: 5.7%-65.9%), BVP trended towards higher LVEF improvement (9.2% ± 9.4% vs 6.4% ± 12.4%; P = 0.085). Interaction between septal scar burden and pacing strategy was significant for ER (P = 0.002) and LVEF improvement (P = 0.011) after propensity score adjustment. During median follow-up of 33.7 (Q1-Q3: 19.8-42.1) months, the composite clinical outcome occurred in 34.7% (n = 51) of patients. The high-burden subgroups had worse clinical outcomes independent of CRT method. CONCLUSIONS Remodeling response to LBBAP and BVP among nonischemic cardiomyopathy patients is modified by septal scar burden. High septal scar burden was associated with poor clinical prognosis independent of CRT methods.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sijin Wu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Gao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanyan Song
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Abu-Alrub S, Strik M, Huntjens P, Haïssaguerre M, Eschalier R, Bordachar P, Ploux S. Current Role of Electrocardiographic Imaging in Patient Selection for Cardiac Resynchronization Therapy. J Cardiovasc Dev Dis 2024; 11:24. [PMID: 38248894 PMCID: PMC10816019 DOI: 10.3390/jcdd11010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
Cardiac resynchronization therapy (CRT) is a recognized therapy for heart failure with altered ejection fraction and abnormal left ventricular activation time. Since the introduction of the therapy, a 30% rate of non-responders is observed and unchanged. The 12-lead ECG remains the only recommended tool for patient selection to CRT. The 12-lead ECG is, however, limited in its inability to provide a precise pattern of regional electrical activity. Electrocardiographic imaging (ECGi) provides a non-invasive detailed mapping of cardiac activation and therefore appears as a promising tool for CRT candidates. The non-invasive ventricular activation maps acquired by ECGi have been primarily explored for the diagnosis and guidance of therapy in patients with atrial or ventricular tachyarrhythmia. However, the accuracy of the system in this field is lacking and needs further improvement before considering a clinical application. On the other hand, its use for patient selection for CRT is encouraging. In this review, we introduce the technical considerations and we describe how ECGi can precisely characterize ventricular activation, especially in patients with left bundle branch block, thus identifying the electrical substrate responsive to CRT.
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Affiliation(s)
- Saer Abu-Alrub
- Cardiology Department, Centre Hospitalier Universitaire Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Marc Strik
- Cardio-Thoracic Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire), 33600 Pessac-Bordeaux, France; (M.S.); (S.P.); (P.B.); (M.H.)
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Peter Huntjens
- Division of Cardiology, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Michel Haïssaguerre
- Cardio-Thoracic Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire), 33600 Pessac-Bordeaux, France; (M.S.); (S.P.); (P.B.); (M.H.)
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Romain Eschalier
- Cardiology Department, Centre Hospitalier Universitaire Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire), 33600 Pessac-Bordeaux, France; (M.S.); (S.P.); (P.B.); (M.H.)
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Sylvain Ploux
- Cardio-Thoracic Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire), 33600 Pessac-Bordeaux, France; (M.S.); (S.P.); (P.B.); (M.H.)
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
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Wijesuriya N, De Vere F, Mehta V, Niederer S, Rinaldi CA, Behar JM. Leadless Pacing: Therapy, Challenges and Novelties. Arrhythm Electrophysiol Rev 2023; 12:e09. [PMID: 37427300 PMCID: PMC10326662 DOI: 10.15420/aer.2022.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/15/2023] [Indexed: 07/11/2023] Open
Abstract
Leadless pacing is a rapidly growing field. Initially designed to provide right ventricular pacing for those who were contraindicated for conventional devices, the technology is growing to explore the potential benefit of avoiding long-term transvenous leads in any patient who requires pacing. In this review, we first examine the safety and performance of leadless pacing devices. We then review the evidence for their use in special populations, such as patients with high risk of device infection, patients on haemodialysis, and patients with vasovagal syncope who represent a younger population who may wish to avoid transvenous pacing. We also summarise the evidence for leadless cardiac resynchronisation therapy and conduction system pacing and discuss the challenges of managing issues, such as system revisions, end of battery life and extractions. Finally, we discuss future directions in the field, such as completely leadless cardiac resynchronisation therapy-defibrillator devices and whether leadless pacing has the potential to become a first-line therapy in the near future.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Felicity De Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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5
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Xing J, Wang S, Bilchick KC, Patel AR, Zhang M. JOINT DEEP LEARNING FOR IMPROVED MYOCARDIAL SCAR DETECTION FROM CARDIAC MRI. PROCEEDINGS. IEEE INTERNATIONAL SYMPOSIUM ON BIOMEDICAL IMAGING 2023; 2023:10.1109/isbi53787.2023.10230541. [PMID: 38523738 PMCID: PMC10959501 DOI: 10.1109/isbi53787.2023.10230541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Automated identification of myocardial scar from late gadolinium enhancement cardiac magnetic resonance images (LGE-CMR) is limited by image noise and artifacts such as those related to motion and partial volume effect. This paper presents a novel joint deep learning (JDL) framework that improves such tasks by utilizing simultaneously learned myocardium segmentations to eliminate negative effects from non-region-of-interest areas. In contrast to previous approaches treating scar detection and myocardium segmentation as separate or parallel tasks, our proposed method introduces a message passing module where the information of myocardium segmentation is directly passed to guide scar detectors. This newly designed network will efficiently exploit joint information from the two related tasks and use all available sources of myocardium segmentation to benefit scar identification. We demonstrate the effectiveness of JDL on LGE-CMR images for automated left ventricular (LV) scar detection, with great potential to improve risk prediction in patients with both ischemic and non-ischemic heart disease and to improve response rates to cardiac resynchronization therapy (CRT) for heart failure patients. Experimental results show that our proposed approach outperforms multiple state-of-the-art methods, including commonly used two-step segmentation-classification networks, and multitask learning schemes where subtasks are indirectly interacted.
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Affiliation(s)
- Jiarui Xing
- Department of Electrical and Computer Engineering, University of Virginia, USA
| | - Shuo Wang
- School of Medicine, University of Virginia Health System, USA
| | | | - Amit R Patel
- School of Medicine, University of Virginia Health System, USA
| | - Miaomiao Zhang
- Department of Electrical and Computer Engineering, University of Virginia, USA
- Department of Computer Science, University of Virginia, USA
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6
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Wijesuriya N, Elliott MK, Mehta V, De Vere F, Strocchi M, Behar JM, Niederer SA, Rinaldi CA. Pacing interventions in non-responders to cardiac resynchronization therapy. Front Physiol 2023; 14:1054095. [PMID: 36776979 PMCID: PMC9909021 DOI: 10.3389/fphys.2023.1054095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
Non-responders to Cardiac Resynchronization Therapy (CRT) represent a high-risk, and difficult to treat population of heart failure patients. Studies have shown that these patients have a lower quality of life and reduced life expectancy compared to those who respond to CRT. Whilst the first-line treatment for dyssynchronous heart failure is "conventional" biventricular epicardial CRT, a range of novel pacing interventions have emerged as potential alternatives. This has raised the question whether these new treatments may be useful as a second-line pacing intervention for treating non-responders, or indeed, whether some patients may benefit from these as a first-line option. In this review, we will examine the current evidence for four pacing interventions in the context of treatment of conventional CRT non-responders: CRT optimization; multisite left ventricular pacing; left ventricular endocardial pacing and conduction system pacing.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom,*Correspondence: Nadeev Wijesuriya,
| | - Mark K. Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Felicity De Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Jonathan M. Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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7
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Wijesuriya N, Elliott MK, Mehta V, Sidhu BS, Behar JM, Niederer S, Rinaldi CA. Leadless left ventricular endocardial pacing for cardiac resynchronization therapy: A systematic review and meta-analysis. Heart Rhythm 2022; 19:1176-1183. [PMID: 35189383 DOI: 10.1016/j.hrthm.2022.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Leadless left ventricular (LV) endocardial pacing to achieve cardiac resynchronization therapy (CRT) is a novel procedure for treatment of patients with dyssynchronous heart failure. Current evidence is limited to observational studies with small patient numbers. OBJECTIVE The purpose of this systematic review and meta-analysis was to assess the safety and efficacy of leadless LV endocardial pacing. METHODS A literature search was conducted through PubMed, EMBASE, and Cochrane databases. Mean differences (MDs) in New York Heart Association (NYHA) functional class and LV ejection fraction (LVEF) from baseline to 6 months postprocedure were combined using a random effects model. Heterogeneity was evaluated using the Cochrane Q test, I2, meta-regression, and sensitivity analysis. Funnel plots were constructed to detect publication bias. RESULTS Five studies with 181 patients were included in the final analysis. Procedural success rate was 90.6%. Clinical response rate was 63%, with mean improvement in NYHA functional class of 0.43 (MD -0.43; 95% confidence interval [CI] -0.76 to -0.1; P = .01), with high heterogeneity (P <.001; I2 = 81.1%). There was a mean increase in LVEF of 6.3% (MD 6.3; 95% CI 4.35-8.19; P <.001, with low heterogeneity (P = 0.84; I2 <0.001%). The echocardiographic response rate was 54%. Procedure-related complication and mortality rates were 23.8% and 2.8%, respectively. CONCLUSION The efficacy of leadless LV endocardial pacing for CRT supports its use as a second-line therapy in patients in whom standard CRT is not possible or has been ineffective. Improvements in safety profile will facilitate widespread uptake in the treatment of these patients.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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8
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Wijesuriya N, Elliott MK, Mehta V, Sidhu BS, Strocchi M, Behar JM, Niederer S, Rinaldi CA. Leadless Left Bundle Branch Area Pacing in Cardiac Resynchronisation Therapy: Advances, Challenges and Future Directions. Front Physiol 2022; 13:898866. [PMID: 35733988 PMCID: PMC9208327 DOI: 10.3389/fphys.2022.898866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Leadless left bundle branch area pacing (LBBAP) represents the merger of two rapidly progressing areas in the field of cardiac resynchronisation therapy (CRT). It combines the attractive concepts of pacing the native conduction system to allow more physiological activation of the myocardium than conventional biventricular pacing, with the potential added benefits of avoiding long-term complications associated with transvenous leads via leadless left ventricular endocardial pacing. This perspective article will first review the evidence for the efficacy of leadless pacing in CRT. We then summarise the procedural steps and pilot data for leadless LBBAP, followed by a discussion of the safety and efficacy of this novel technique. Finally, we will examine how further mechanistic evidence may shed light to which patients may benefit most from leadless LBBAP, and how improvements in current experience and technology could promote widespread uptake and expand current clinical indications.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark K. Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baldeep S. Sidhu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Jonathan M. Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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9
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Aimo A, Vergaro G, González A, Barison A, Lupón J, Delgado V, Richards AM, de Boer RA, Thum T, Arfsten H, Hülsmann M, Falcao-Pires I, Díez J, Foo RSY, Chan MYY, Anene-Nzelu CG, Abdelhamid M, Adamopoulos S, Anker SD, Belenkov Y, Ben Gal T, Cohen-Solal A, Böhm M, Chioncel O, Jankowska EA, Gustafsson F, Hill L, Jaarsma T, Januzzi JL, Jhund P, Lopatin Y, Lund LH, Metra M, Milicic D, Moura B, Mueller C, Mullens W, Núñez J, Piepoli MF, Rakisheva A, Ristić AD, Rossignol P, Savarese G, Tocchetti CG, van Linthout S, Volterrani M, Seferovic P, Rosano G, Coats AJS, Emdin M, Bayes-Genis A. Cardiac remodelling - Part 2: Clinical, imaging and laboratory findings. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2022; 24:944-958. [PMID: 35488811 DOI: 10.1002/ejhf.2522] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/06/2022] Open
Abstract
In patients with heart failure, the beneficial effects of drug and device therapies counteract to some extent ongoing cardiac damage. According to the net balance between these two factors, cardiac geometry and function may improve (reverse remodelling, RR) and even completely normalize (remission), or vice versa progressively deteriorate (adverse remodelling, AR). RR or remission predict a better prognosis, while AR has been associated with worsening clinical status and outcomes. The remodelling process ultimately involves all cardiac chambers, but has been traditionally evaluated in terms of left ventricular volumes and ejection fraction. This is the second part of a review paper by the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology dedicated to ventricular remodelling. This document examines the proposed criteria to diagnose RR and AR, their prevalence and prognostic value, and the variables predicting remodelling in patients managed according to current guidelines. Much attention will be devoted to RR in patients with heart failure with reduced ejection fraction because most studies on cardiac remodelling focused on this setting.
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Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Arantxa González
- CIMA Universidad de Navarra, and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Andrea Barison
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Josep Lupón
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
| | - Victoria Delgado
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Thomas Thum
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Henrike Arfsten
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Martin Hülsmann
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Javier Díez
- Center for Applied Medical Research, Pamplona, Spain
| | - Roger S Y Foo
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | - Mark Yan Yee Chan
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | - Chukwuemeka G Anene-Nzelu
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | | | - Stamatis Adamopoulos
- 2nd Department of Cardiovascular Medicine, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapy (BCRT), German Center for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Tuvia Ben Gal
- Cardiology Department, Rabin Medical Center, Beilinson, Israel
| | | | - Michael Böhm
- University of the Saarland, Homburg/Saar, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu' Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | - Ewa A Jankowska
- Institute of Heart Disases, Wroclaw Medical University, Wroclaw, Poland
| | - Finn Gustafsson
- Heart Centre, Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA
| | | | - Yuri Lopatin
- Volgograd State Medical University, Volgograd, Russia
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Metra
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davor Milicic
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | | | | | - Julio Núñez
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Massimo F Piepoli
- Cardiology Division, Castelsangiovanni Hospital, Castelsangiovanni, Italy
| | - Amina Rakisheva
- Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigations Cliniques-Plurithématique 1433 and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Carlo G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Sophie van Linthout
- Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | | | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe Rosano
- St. George's Hospitals, NHS Trust, University of London, London, UK
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Antoni Bayes-Genis
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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10
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Martins R, António N, Donato H, Oliveiros B. Predictors of echocardiographic response to cardiac resynchronization therapy: A systematic review with Meta-Analysis. IJC HEART & VASCULATURE 2022; 39:100979. [PMID: 35252540 PMCID: PMC8891947 DOI: 10.1016/j.ijcha.2022.100979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/30/2022] [Accepted: 02/20/2022] [Indexed: 11/17/2022]
Abstract
NYHA class II seems to predict response to CRT. We should not delay CRT, trying medical management first, even in mildly symptomatic patients. Atrial fibrillation patients must have the same indication for CRT as those in sinus rhythm.
Background At least 30% of the patients do not respond to cardiac resynchronization therapy (CRT). We performed a systematic review and meta-analysis of real-world studies trying to identify predictors of response to CRT. Methods PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for observational prospective studies, referring the evaluation of response to CRT, defined as a decrease in left ventricle end-systolic volume (LVESV) ≥ 15% at 6-month follow-up, via two-dimensional echocardiography. Results A total of 24 studies were included. The meta-analysis showed that female gender (p = 0.018), non-ischemic cardiomyopathy (NICM) (p < 0.001), left bundle branch morphology (LBBB) (p = 0.001), longer QRS (p < 0.001) and New York Heart Association (NYHA) class II (p = 0.014) appear to favor response to CRT. After ROC analysis and logistic regression procedures, female gender (kappa = 0.450; p < 0.001), NICM (kappa = 0.636; p < 0.001), LBBB (kappa = 0.935; p < 0.001), and NYHA class II (kappa = 0.647; p < 0.001) were identified as independent predictors of response to CRT, being LBBB the most reliable one (sensitivity = 97.24%; specificity = 98.86%). Conclusions Female gender, NICM, LBBB and NYHA class II are baseline variables with an apparent capability to independently predict response to CRT, being LBBB the most reliable one.
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Affiliation(s)
- Rodrigo Martins
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Natália António
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Corresponding author.
| | - Helena Donato
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
- Serviço de Documentação, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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11
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Zhang X, Qian Z, Tang H, Hua W, Su Y, Xu G, Liu X, Xue X, Fan J, Cai L, Zhu L, Wang Y, Hou X, Garcia EV, Zhou W, Zou J. A new method to recommend left ventricular lead positions for improved CRT volumetric response and long-term prognosis. J Nucl Cardiol 2021; 28:672-684. [PMID: 31111449 PMCID: PMC10959571 DOI: 10.1007/s12350-019-01735-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Using ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), we sought to develop and validate a new method to recommend left ventricular (LV) lead positions in order to improve volumetric response and long-term prognosis after cardiac resynchronization therapy (CRT). METHODS Seventy-nine patients received gated SPECT MPI at baseline, and echocardiography at baseline and follow-up. The volumetric response referred to a reduction of ≥ 15% in LV end-systolic volume 6 months after CRT. After excluding apical, septal, and scarred segments, there were three levels of recommended segments: (1) the optimal recommendation: the latest contracting viable segment; (2) the 2nd recommendation: the late contracting viable segments whose contraction delays were within 10° of the optimal recommendation; and (3) the 3rd recommendation: the viable segments adjacent to the optimal recommendation when there was no late contracting viable segment. RESULTS After excluding 11 patients whose LV lead was placed in apical or scarred segments, 75.6% of the patients concordant to recommended LV segments (n = 41) responded to CRT while 51.9% of those with non-recommended LV lead locations (n = 27) were responders (P = .043). Response rates were 76.9%, 76.9% , and 73.3% (P = .967), respectively, when LV lead was implanted in the optimal recommendation (n = 13), the 2nd recommendation (n = 13), and the 3rd recommendation (n = 15). LV leads placed at recommended segments reduced composite events of all-cause mortality or heart failure (HF) rehospitalization compared with pacing at non-recommended segments (log-rank χ2 = 5.623, P = .018). CONCLUSIONS Pacing in the recommended LV lead segments identified on gated SPECT MPI was associated with improved volumetric response to CRT and long-term prognosis.
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Affiliation(s)
- Xinwei Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Haipeng Tang
- School of Computing, University of Southern Mississippi, 730 Beach Blvd E, Long Beach, MS, 39560, USA
| | - Wei Hua
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Geng Xu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xingbin Liu
- Department of Cardiology, Westeastern Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Xue
- Department of Cardiology, Affiliated Hospital, Xian Jiaotong University, Xi'an, China
| | - Jie Fan
- Department of Cardiology, Yunnan Province Hospital, Kunming, China
| | - Lin Cai
- Department of Cardiology, Chengdu Third Hospital, Chengdu, China
| | - Li Zhu
- Department of Cardiology, Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, 730 Beach Blvd E, Long Beach, MS, 39560, USA.
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China.
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12
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Mitropoulou P, Georgiopoulos G, Figliozzi S, Klettas D, Nicoli F, Masci PG. Multi-Modality Imaging in Dilated Cardiomyopathy: With a Focus on the Role of Cardiac Magnetic Resonance. Front Cardiovasc Med 2020; 7:97. [PMID: 32714942 PMCID: PMC7343712 DOI: 10.3389/fcvm.2020.00097] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/07/2020] [Indexed: 12/20/2022] Open
Abstract
Heart failure (HF) is recognized as a leading cause of morbidity and mortality worldwide. Dilated cardiomyopathy (DCM) is a common phenotype in patients presenting with HF. Timely diagnosis, appropriate identification of the underlying cause, individualized risk stratification, and prediction of clinical response to treatment have improved the prognosis of DCM over the last few decades. In this article, we reviewed the current evidence on available imaging techniques used for DCM patients. In this direction, we evaluated appropriate scenarios for the implementation of echocardiography, nuclear imaging, and cardiac computed tomography, and we focused on the primordial role that cardiac magnetic resonance (CMR) holds in the diagnosis, prognosis, and tailoring of therapeutic options in this population of special clinical interest. We explored the predictive value of CMR toward left ventricular reverse remodeling and prediction of sudden cardiac death, thus guiding the decisions for device therapy. Principles underpinning the use of state-of-the-art CMR techniques such as parametric mapping and feature-tracking strain analysis are also provided, along with expectations for the anticipated future advances in this field. We also attempted to correlate the evidence with clinical practice, with the intent to address questions on selecting the optimal imaging method for different indications and clinical needs. Overall, we recommend a comprehensive assessment of DCM patients at baseline and at follow-up intervals depending on the clinical status, with the addition of CMR as a second-line modality to other imaging techniques. We also provide an algorithm to guide the detailed imaging approach of the patient with DCM. We expect that future guidelines will upgrade their clinical recommendations for the utilization of CMR in DCM, which is expected to further improve the quality of care and the outcomes. This review provides an up-to-date perspective on the imaging of dilated cardiomyopathy patients and will be of clinical value to training doctors and physicians involved in the area of heart failure.
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Affiliation(s)
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefano Figliozzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
| | - Dimitrios Klettas
- First Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Flavia Nicoli
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
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13
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Katbeh A, Van Camp G, Barbato E, Galderisi M, Trimarco B, Bartunek J, Vanderheyden M, Penicka M. Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach. Cardiology 2019; 142:116-128. [PMID: 31117077 DOI: 10.1159/000499192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
Since the first report on biventricular pacing in 1994, cardiac resynchronization therapy (CRT) has become standard for patients with advanced heart failure (HF) and ventricular conduction delay. CRT improves myocardial function by resynchronizing myocardial contraction, which results in reverse left ventricular remodeling and improves symptoms and clinical outcomes. Despite the accelerated development of CRT device technology and its increased application in treating HF patients, almost one-third of these patients do not respond to the therapy or gain any clinical benefit from device implantation. Over the last decade, multiple cardiac imaging modalities have provided a deeper understanding of myocardial pathophysiology, thereby improving HF treatment management. However, the optimal strategy for improving the CRT response remains debatable. This article provides an updated overview of the electropathophysiology of myocardial dysfunction in ventricular conduction delay and the diagnostic approaches involving the use of multiple modalities.
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Affiliation(s)
- Asim Katbeh
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium,
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14
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Yagishita D, Shoda M, Yagishita Y, Ejima K, Hagiwara N. Reply to the Editor- Augmenting speed of conduction to improve CRT. Heart Rhythm 2019; 16:e57-e58. [PMID: 30954604 DOI: 10.1016/j.hrthm.2019.04.004] [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: 04/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yoshimi Yagishita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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15
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Time interval from left ventricular stimulation to QRS onset is a novel predictor of nonresponse to cardiac resynchronization therapy. Heart Rhythm 2019; 16:395-402. [DOI: 10.1016/j.hrthm.2018.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Indexed: 11/23/2022]
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16
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Chen JS, Niu XW, Chen FM, Yao YL. Etiologic impact on difference on clinical outcomes of patients with heart failure after cardiac resynchronization therapy: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13725. [PMID: 30593144 PMCID: PMC6314735 DOI: 10.1097/md.0000000000013725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To compare long-term clinical outcomes between patients with heart failure due to non-ischemic cardiomyopathy (NICM) and those due to ischemic cardiomyopathy (ICM) after cardiac resynchronization therapy (CRT). METHODS AND RESULTS EMbase, PubMed, and Cochrane Library were searched for published studies up to December 2017. Twenty-one observational studies with 12,331 patients were enrolled in the present meta-analysis. The results demonstrated that the all-cause mortality in NICM patients was significantly lower than that in ICM patients (RR 1.37, 95% CI 1.16-1.61). In terms of echocardiographic parameters, NICM patients exhibited statistically significant improvement in left ventricular ejection fraction (LVEF) (MD 2.70, 95%CI -4.13 to -1.28), and a significant decrement in left ventricular end-systolic volume (LVESV) (MD 10.41,95% CI 2.10-18.73) and left ventricular end diastolic diameter (LVEDD) (MD 7.63, 95% CI 2.59-12.68) as compared with ICM patients. No significant difference was observed in the improvement of New York Heart Association Functional Classification (MD 0.05, 95% CI -0.05 to 0.15), pulmonary arterial systolic pressure (PASP) (MD -0.61, 95% CI -4.36 to 3.14), and severity of mitral regurgitation (MD 0.00, 95% CI -0.08 to 0.07) between the 2 groups. CONCLUSIONS Our meta-analysis illustrated that patients with HF due to NICM tended to have better clinical outcomes and LV reverse remodeling as compared with those due to ICM. This finding may help clinicians select patients who respond favorably to CRT, though further research is required to clarify the potential confounding factors and underlying mechanisms for this phenomenon.
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Affiliation(s)
- Jian-Shu Chen
- The First Clinical Medicine College of Lanzhou University
| | - Xiao-Wei Niu
- The First Clinical Medicine College of Lanzhou University
| | - Fen-mei Chen
- The First Clinical Medicine College of Lanzhou University
| | - Ya-Li Yao
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, GS, China
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17
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Bisson A, Pucheux J, Andre C, Bernard A, Pierre B, Babuty D, Fauchier L, Clementy N. Localization of Left Ventricular Lead Electrodes in Relation to Myocardial Scar in Patients Undergoing Cardiac Resynchronization Therapy. J Am Heart Assoc 2018; 7:e009502. [PMID: 30373444 PMCID: PMC6404211 DOI: 10.1161/jaha.118.009502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The efficacy of cardiac resynchronization therapy may be reduced in the event of pacing within myocardial fibrosis. We aimed to develop a method to determine the anatomical relationships between the left ventricular (LV) lead and myocardial fibrosis. Methods and Results In consecutive patients indicated for cardiac resynchronization therapy, cardiovascular magnetic resonance imaging with late gadolinium enhancement assessment was performed before implantation. After implantation, an injected computed tomography scanner (CT scan) was performed. The 2 imaging techniques were fused to assess the LV lead position relative to myocardial scar. A total of 68 patients were included. Myocardial scar was found in 29 (43%) and was localized in lateral segments in 14 (21%). Scar was significantly associated with male sex, ischemic cardiomyopathy, a Selvester score adapted to left bundle branch block (LBBB Selvester), and Selvester criteria for localizing lateral fibrosis (V2 S/S′ ratio). Image fusion was feasible in all patients. Position within myocardial scar was confirmed for 6 electrodes in 3 patients. Prolonged QRS duration during LV pacing ≥139% predicted electrode positioning within scar tissue (sensitivity, 83%; specificity, 91%; P=0.002). Conclusions In cardiac resynchronization therapy patients, fusion between preimplantation cardiovascular magnetic resonance and a postimplantation injected computed tomography scan is a feasible technique. Prolongation of the QRS duration during LV pacing predicts pacing within myocardial scar. Accurate location of LV lead pacing electrodes on the epicardial surface relative to myocardial scar, either by imaging or ECG analyses, may help improve cardiac resynchronization therapy response in selected patients.
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Affiliation(s)
- Arnaud Bisson
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Julien Pucheux
- 2 Radiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Clémentine Andre
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Anne Bernard
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Bertrand Pierre
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Dominique Babuty
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Laurent Fauchier
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Nicolas Clementy
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
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18
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Andre C, Piver E, Perault R, Bisson A, Pucheux J, Vermes E, Pierre B, Fauchier L, Babuty D, Clementy N. Galectin-3 predicts response and outcomes after cardiac resynchronization therapy. J Transl Med 2018; 16:299. [PMID: 30390680 PMCID: PMC6215623 DOI: 10.1186/s12967-018-1675-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) reduces symptoms, morbidity and mortality in chronic heart failure patients with wide QRS complexes. However, approximately one third of CRT patients are non-responders. Myocardial fibrosis is known to be associated with absence of response. We sought to see whether galectin-3, a promising biomarker involved in fibrosis processes, could predict response and outcomes after CRT. METHODS Consecutive patients eligible for implantation of a CRT device with a typical left bundle branch block ≥ 120 ms were prospectively included. Serum Gal-3 level, Selvester ECG scoring, and cardiac magnetic resonance with analysis of late gadolinium enhancement (LGE) were ascertained. Response to CRT was defined by a composite endpoint at 6 months: no death, nor hospitalization for major cardiovascular event, and a significant decrease in left ventricular end-systolic volume of 15% or more. RESULTS Sixty-one patients were included (age 61 ± 5 years, ejection fraction 27 ± 5%), 59% with non-ischemic cardiomyopathy. At 6 months, 49 patients (80%) were considered responders. Responders had a lower percentage of LGE (8 ± 13% vs 22 ± 16%, p = 0.006), and a trend towards lower rates of galectin-3 (16 ± 6 ng/mL vs 19 ± 8 ng/mL, p = 0.13). LGE ≥ 14% and Gal-3 ≥ 22 ng/mL independently predicted response to CRT (OR = 0.17 [0.03-0.62], p = 0.007, and OR = 0.11 [0.02-0.04], p < 0.001, respectively). At 48 months of follow-up, 12 patients had been hospitalized for a major cardiovascular event or had died. Galectin-3 level predicted long-term outcomes (HR = 3.31 [1.00-11.34], p = 0.05). CONCLUSIONS Gal-3 serum level predicts the response to CRT at 6 months and long-term outcomes in chronic heart failure patients.
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Affiliation(s)
- Clémentine Andre
- Cardiology Department, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Eric Piver
- Biochemistry Department, Trousseau Hospital, University of Tours, Tours, France
| | - Romain Perault
- Cardiology Department, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Arnaud Bisson
- Cardiology Department, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Julien Pucheux
- Imaging Department, Trousseau Hospital, University of Tours, Tours, France
| | - Emmanuelle Vermes
- Imaging Department, Trousseau Hospital, University of Tours, Tours, France
| | - Bertrand Pierre
- Cardiology Department, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Dominique Babuty
- Cardiology Department, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Nicolas Clementy
- Cardiology Department, Trousseau Hospital, University of Tours, 37044 Tours, France
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19
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Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Behar JM, Claridge S, Niederer S, Rinaldi CA. Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy. Expert Rev Med Devices 2018; 15:555-570. [PMID: 30019954 PMCID: PMC6178093 DOI: 10.1080/17434440.2018.1502084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/12/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment. AREAS COVERED This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT. EXPERT COMMENTARY Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.
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Affiliation(s)
- Benjamin J. Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
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20
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Yoneyama K, Kitanaka Y, Tanaka O, Akashi YJ. Cardiovascular magnetic resonance imaging in heart failure. Expert Rev Cardiovasc Ther 2018; 16:237-248. [PMID: 29478345 DOI: 10.1080/14779072.2018.1445525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Heart failure is a complex clinical syndrome resulting from heart structural remodeling and impaired function in ejecting blood; its incidence is increasing markedly worldwide. The observed variations in the structure and function of the heart are attributable to differences in etiology of heart failure. Cardiac magnetic resonance imaging (CMR) can characterize myocardial tissue, assess myocardial viability, and help diagnose specific cardiomyopathies. The emergence of T1 mapping techniques further improves our knowledge and the clinical assessment of myocardial diffuse fibrosis. Physicians, therefore, must identify the variations using CMR to improve patient's symptoms, survival, and quality of life. Area covered: Current reports regarding CMR and the evidence for heart failure diagnosis and therapy as a potential marker of therapeutic response, including low- and high-risk patients, were reviewed. Literature search was performed using PubMed and Google Scholar for literature relevant to CMR, late gadolinium enhancement, T1 mapping, assessment of fibrosis and remodeling, coronary artery, myocardial infarction, heart failure, and its outcomes. Expert commentary: The authors review current evidence and discuss the potential ability of CMR to guide, diagnose, plan risk strategies, and treat patients with heart failure.
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Affiliation(s)
- Kihei Yoneyama
- a Division of Cardiology, Department of Internal Medicine , St. Marianna University School of Medicine , Kawasaki , Japan.,b Heart Disease Center , St. Marianna University School of Medicine Toyoko hospital , Kawasaki , Japan
| | - Yuki Kitanaka
- c Department of Radiology , St. Marianna University School of Medicine Toyoko hospital , Kawasaki , Japan
| | - Osamu Tanaka
- b Heart Disease Center , St. Marianna University School of Medicine Toyoko hospital , Kawasaki , Japan
| | - Yoshihiro J Akashi
- a Division of Cardiology, Department of Internal Medicine , St. Marianna University School of Medicine , Kawasaki , Japan
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21
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Gazzoni GF, Fraga MB, Ferrari ADL, Soliz PDC, Borges AP, Bartholomay E, Kalil CAA, Giaretta V, Rohde LEP. Predictors of Total Mortality and Echocardiographic Response for Cardiac Resynchronization Therapy: A Cohort Study. Arq Bras Cardiol 2017; 109:569-578. [PMID: 29185615 PMCID: PMC5783438 DOI: 10.5935/abc.20170171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/09/2017] [Indexed: 01/02/2023] Open
Abstract
Background Clinical studies demonstrate that up to 40% of patients do not respond to
cardiac resynchronization therapy (CRT), thus, appropriate patient selection
is critical to the success of CRT in heart failure. Objective Evaluation of mortality predictors and response to CRT in the Brazilian
scenario. Methods Retrospective cohort study including patients submitted to CRT in a tertiary
hospital in southern Brazil from 2008 to 2014. Survival was assessed through
a database of the State Department of Health (RS). Predictors of
echocardiographic response were evaluated using Poisson regression. Survival
analysis was performed by Cox regression and Kaplan Meyer curves. A
two-tailed p value less than 0.05 was considered statistically
significant. Results A total of 170 patients with an average follow-up of 1011 ± 632 days
were included. The total mortality was 30%. The independent predictors of
mortality were age (hazard ratio [HR] of 1.05, p = 0.027), previous acute
myocardial infarction (AMI) (HR of 2.17, p = 0.049) and chronic obstructive
pulmonary disease (COPD) (HR of 3.13, p = 0.015). The percentage of
biventricular stimulation at 6 months was identified as protective factor of
mortality ([HR] 0.97, p = 0.048). The independent predictors associated with
the echocardiographic response were absence of mitral insufficiency,
presence of left bundle branch block and percentage of biventricular
stimulation. Conclusion Mortality in patients submitted to CRT in a tertiary hospital was
independently associated with age, presence of COPD and previous AMI. The
percentage of biventricular pacing evaluated 6 months after resynchronizer
implantation was independently associated with improved survival and
echocardiographic response.
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Affiliation(s)
- Guilherme Ferreira Gazzoni
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Porto Alegre, RS - Brazil.,Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | - Matheus Bom Fraga
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Porto Alegre, RS - Brazil
| | - Andres Di Leoni Ferrari
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Porto Alegre, RS - Brazil
| | - Pablo da Costa Soliz
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Porto Alegre, RS - Brazil
| | - Anibal Pires Borges
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Porto Alegre, RS - Brazil
| | - Eduardo Bartholomay
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Porto Alegre, RS - Brazil
| | | | - Vanessa Giaretta
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | - Luis Eduardo Paim Rohde
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
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22
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Gu M, Jin H, Hua W, Fan XH, Ding LG, Wang J, Niu HX, Cai C, Zhang S. Repetitive optimizing left ventricular pacing configurations with quadripolar leads improves response to cardiac resynchronization therapy: A single-center randomized clinical trial. Medicine (Baltimore) 2017; 96:e8066. [PMID: 28906405 PMCID: PMC5604674 DOI: 10.1097/md.0000000000008066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to investigate whether repetitive optimizing left ventricular pacing configurations (LVPCs) with quadripolar leads (QUAD) can improve response to cardiac resynchronization therapy (CRT). METHODS Fifty-two eligible patients were enrolled and 1:1 randomized to either the quadripolar LV leads (QUAD) group or the conventional bipolar leads (CONV) group. In the QUAD group, optimization of LVPC was performed for all patients before discharge and for nonresponders at 3 months follow-up. Clinical evaluations and transthoracic echocardiograms were performed before, 3, and 6 months after CRT implantation. RESULTS At 3 months follow-up, 16 of 25 (64%) patients in the CONV group (1 patient was lost to follow-up) and 18 of 26 (69%) patients in the QUAD group were classified as responders. After optimizing the LVPCs in 3-month nonresponders in the QUAD group, 21 of 26 (80.8%) patients in the QUAD group were classified as responders at 6 months as compared with 17 of 25 (68%) patients in the CONV group. Left ventricular end-systolic volume (LVESV) reduction, left ventricular ejection fraction (LVEF) increase, and New York Heart Association (NYHA) functional class reduction at 6 months were significantly greater in the QUAD group than in the CONV group (LVESV: -26.9 ± 13.8 vs -17.2 ± 13.3%; P = .013; LVEF: +12.7 ± 8.0 vs +7.8 ± 6.3 percentage points; P = .017; NYHA: -1.27 ± 0.67 vs -0.72 ± 0.54 functional classes; P = .002). CONCLUSIONS Compared with conventional bipolar leads, CRT using quadripolar leads with repetitive optimized LVPCs resulted in an additional increase in LVEF and reduction in LVESV and NYHA functional class at 6-month follow-up.
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23
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Behar JM, Mountney P, Toth D, Reiml S, Panayiotou M, Brost A, Fahn B, Karim R, Claridge S, Jackson T, Sieniewicz B, Patel N, O'Neill M, Razavi R, Rhode K, Rinaldi CA. Real-Time X-MRI-Guided Left Ventricular Lead Implantation for Targeted Delivery of Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2017; 3:803-814. [PMID: 29759775 DOI: 10.1016/j.jacep.2017.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to test the feasibility of a purpose-built, integrated software platform to process, analyze, and overlay cardiac magnetic resonance (CMR) data in real time within a combined cardiac catheter laboratory and magnetic resonance imaging scanner suite (X-MRI) to guide left ventricular (LV) lead implantation. BACKGROUND Suboptimal LV lead position is a major determinant of poor cardiac resynchronization therapy (CRT) response, and the optimal site is highly patient specific. Pacing myocardial scar is associated with poorer outcomes; conversely, targeting latest mechanical activation (LMA) may improve them. METHODS Fourteen patients (age 74 ± 5.1 years; New York Heart Association functional class: 2.7 ± 0.4; 86% ischemic with ejection fraction 27 ± 7.6%; QRSd: 157 ± 19 ms) underwent CMR followed by immediate CRT implantation using derived scar and dyssynchrony data, overlaid onto fluoroscopy in an X-MRI suite. Rapid LV segmentation enabled detailed scar quantification, identification of LMA segments, and selection of myocardial targets. At coronary venography, the CMR-derived 3-dimensional shell was fused, enabling identification of viable venous targets subtended by target segments for LV lead placement. RESULTS The platform was successful in all 14 patients, of whom 10 (71%) were paced in pre-procedurally defined target segments. Pacing in CMR-defined target segments (out of scar) showed a significant decrease in the LV capture threshold (mean difference: 2.4 [1.5 to 3.2]; p < 0.001) and shorter paced QRS duration (mean difference: 25 [15 to 34]; p < 0.001) compared with pacing in areas of CMR determined scar. In 5 (36%) patients with extensive scar in the posterolateral wall, CMR guidance enabled successful lead delivery in an alternative anatomically favorable site. Radiation dose and implant times were similar to historical controls (p = NS). CONCLUSIONS Real-time CMR-guided LV lead placement is feasible and achievable in a single clinical setting and may prove helpful to preferentially select sites for LV lead placement.
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Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom.
| | - Peter Mountney
- Medical Imaging Technologies, Siemens Healthineers, Princeton, New Jersey
| | - Daniel Toth
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom; Siemens Healthineers, Frimley, Camberley, United Kingdom
| | | | - Maria Panayiotou
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | | | | | - Rashed Karim
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Simon Claridge
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Ben Sieniewicz
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Nik Patel
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Mark O'Neill
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Kawal Rhode
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Christopher Aldo Rinaldi
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
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24
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Foley JRJ, Plein S, Greenwood JP. Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques. World J Cardiol 2017; 9:92-108. [PMID: 28289524 PMCID: PMC5329750 DOI: 10.4330/wjc.v9.i2.92] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/15/2016] [Accepted: 12/02/2016] [Indexed: 02/07/2023] Open
Abstract
Coronary artery disease (CAD) is a leading cause of death and disability worldwide. Cardiovascular magnetic resonance (CMR) is established in clinical practice guidelines with a growing evidence base supporting its use to aid the diagnosis and management of patients with suspected or established CAD. CMR is a multi-parametric imaging modality that yields high spatial resolution images that can be acquired in any plane for the assessment of global and regional cardiac function, myocardial perfusion and viability, tissue characterisation and coronary artery anatomy, all within a single study protocol and without exposure to ionising radiation. Advances in technology and acquisition techniques continue to progress the utility of CMR across a wide spectrum of cardiovascular disease, and the publication of large scale clinical trials continues to strengthen the role of CMR in daily cardiology practice. This article aims to review current practice and explore the future directions of multi-parametric CMR imaging in the investigation of stable CAD.
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25
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Behar JM, Claridge S, Jackson T, Sieniewicz B, Porter B, Webb J, Rajani R, Kapetanakis S, Carr-White G, Rinaldi CA. The role of multi modality imaging in selecting patients and guiding lead placement for the delivery of cardiac resynchronization therapy. Expert Rev Cardiovasc Ther 2016; 15:93-107. [DOI: 10.1080/14779072.2016.1252674] [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] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Simon Claridge
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Tom Jackson
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Ben Sieniewicz
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Bradley Porter
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Jessica Webb
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Ronak Rajani
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | | | | | - Christopher A Rinaldi
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
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26
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Nguyên UC, Mafi-Rad M, Aben JP, Smulders MW, Engels EB, van Stipdonk AMW, Luermans JGLM, Bekkers SCAM, Prinzen FW, Vernooy K. A novel approach for left ventricular lead placement in cardiac resynchronization therapy: Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging. Heart Rhythm 2016; 14:110-119. [PMID: 27663606 DOI: 10.1016/j.hrthm.2016.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Placing the left ventricular (LV) lead at a site of late electrical activation remote from scar is desired to improve cardiac resynchronization therapy (CRT) response. OBJECTIVE The purpose of this study was to integrate coronary venous electroanatomic mapping (EAM) with delayed enhancement cardiac magnetic resonance (DE-CMR) enabling LV lead guidance to the latest activated vein remote from scar. METHODS Eighteen CRT candidates with focal scar on DE-CMR were prospectively included. DE-CMR images were semi-automatically analyzed. Coronary venous EAM was performed intraprocedurally and integrated with DE-CMR to guide LV lead placement in real time. Image integration accuracy and electrogram parameters were evaluated offline. RESULTS Integration of EAM and DE-CMR was achieved using 8.9 ± 2.8 anatomic landmarks and with accuracy of 4.7 ± 1.1 mm (mean ± SD). Maximal electrical delay ranged between 72 and 197ms (57%-113% of QRS duration) and was heterogeneously located among individuals. In 12 patients, the latest activated vein was located outside scar, and placing the LV lead in the latest activated vein remote from scar was accomplished in 10 patients and prohibited in 2 patients. In the other 6 patients, the latest activated vein was located in scar, and targeting alternative veins was considered. Unipolar voltages were on average lower in scar compared to nonscar (6.71 ± 3.45 mV vs 8.18 ± 4.02 mV [median ± interquartile range), P <.001) but correlated weakly with DE-CMR scar extent (R -0.161, P <.001) and varied widely among individual patients. CONCLUSION Integration of coronary venous EAM with DE-CMR can be used during CRT implantation to guide LV lead placement to the latest activated vein remote from scar, possibly improving CRT.
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Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
| | - Masih Mafi-Rad
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Martijn W Smulders
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Elien B Engels
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
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27
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Xia X, Ruwald AC, Ruwald MH, Ugoeke N, Szepietowska B, Kutyifa V, Aktas MK, Thomsen PEB, Zareba W, Moss AJ, Couderc JP. Validation of an automatic diagnosis of strict left bundle branch block criteria using 12-lead electrocardiograms. Ann Noninvasive Electrocardiol 2016; 22. [PMID: 27572179 DOI: 10.1111/anec.12398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Strict left bundle branch block (LBBB) criteria were recently proposed to identify LBBB patients to benefit most from cardiac resynchronization therapy (CRT). The aim of our study was to automate identification of strict LBBB in order to facilitate its broader application. METHODS We developed a series of algorithms to automatically detect and measure parameters required for strict LBBB criteria and proposed a definition of QRS notch detection. The algorithms were developed using training (n = 20) and validation (n = 592) sets consisting of signal-averaged 12-lead ECGs (1,000 Hz sampling) recorded from 612 LBBB patients from Multicenter Automatic Defibrillator Implantation Trial-CRT. Four trained clinicians independently performed adjudication on 148 different ECGs for comparing automatic and manually adjudicated results, in addition to 13 ECGs for evaluation of intraobserver variability and 32 ECGs for interobserver variability. We assessed the performance of the automated algorithms using manually adjudicated ECGs as references. RESULTS Overall sensitivity and specificity for detecting strict LBBB were 95% and 86%, respectively. The mean absolute deviation (MAD) of QRS duration and notch/slur locations for the automated method versus the manual method was below 1 ms, and MAD values were lower than 2 ms for interobserver and intraobserver variability. Sensitivity and specificity for detecting notch and slur locations were 87% and 96% for notches and 78% and 90% for slurs using the automatic method. In addition 95% and 93% agreements for notches and 90% and 88% agreements for slurs were reached for intra- and interobserver. CONCLUSION The proposed algorithms automatically measure QRS features for the diagnosis of strict LBBB. Our study shows good performance in reference to manual results.
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Affiliation(s)
- Xiaojuan Xia
- Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA
| | - Anne-Christine Ruwald
- Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA.,Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Martin H Ruwald
- Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA.,Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nene Ugoeke
- Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA
| | | | - Valentina Kutyifa
- Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA
| | - Mehmet K Aktas
- Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA
| | | | - Wojciech Zareba
- Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA
| | - Arthur J Moss
- Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA
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28
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Zhang Y, Guallar E, Weiss RG, Stillabower M, Gerstenblith G, Tomaselli GF, Wu KC. Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients. Heart Rhythm 2016; 13:1661-6. [PMID: 27108939 DOI: 10.1016/j.hrthm.2016.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) improves over time in 25%-40% of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. OBJECTIVES We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. METHODS We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar. LVEF was reassessed at least once after ICD implantation. RESULTS Over a mean follow-up of 3 years, LVEF decreased in 43 (21.3%), improved in 88 (43.6%), and was unchanged in 71 (35.1%) of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure hospitalizations. CONCLUSION Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline cardiac magnetic resonance imaging of the myocardial substrate may provide important prognostic information on subsequent left ventricular remodeling and adverse events.
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Affiliation(s)
- Yiyi Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eliseo Guallar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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29
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Abstract
Echocardiography is used in cardiac resynchronisation therapy (CRT) to assess cardiac function, and in particular left ventricular (LV) volumetric status, and prediction of response. Despite its widespread applicability, LV volumes determined by echocardiography have inherent measurement errors, interobserver and intraobserver variability, and discrepancies with the gold standard magnetic resonance imaging. Echocardiographic predictors of CRT response are based on mechanical dyssynchrony. However, parameters are mainly tested in single-centre studies or lack feasibility. Speckle tracking echocardiography can guide LV lead placement, improving volumetric response and clinical outcome by guiding lead positioning towards the latest contracting segment. Results on optimisation of CRT device settings using echocardiographic indices have so far been rather disappointing, as results suffer from noise. Defining response by echocardiography seems valid, although re-assessment after 6 months is advisable, as patients can show both continuous improvement as well as deterioration after the initial response. Three-dimensional echocardiography is interesting for future implications, as it can determine volume, dyssynchrony and viability in a single recording, although image quality needs to be adequate. Deformation patterns from the septum and the derived parameters are promising, although validation in a multicentre trial is required. We conclude that echocardiography has a pivotal role in CRT, although clinicians should know its shortcomings.
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30
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Daoulah A, Alsheikh-Ali AA, Al-Faifi SM, Ocheltree SR, Haq E, Asrar FM, Fathey A, Haneef AA, Al Mousily F, O ES, Lotfi A. Cardiac resynchronization therapy in patients with postero-lateral scar by cardiac magnetic resonance: A systematic review and meta-analysis. J Electrocardiol 2015; 48:783-90. [DOI: 10.1016/j.jelectrocard.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Indexed: 10/23/2022]
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31
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CHEN LU, FU HAIXIA, PRETORIUS VICTORG, YANG DACHUN, WISTE HEATHERJ, YUAN HONGTAO, FELD GREGORYK, CHA YONGMEI, BIRGERSDOTTER-GREEN ULRIKAM. Clinical Outcomes of Cardiac Resynchronization with Epicardial Left Ventricular Lead. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1201-9. [DOI: 10.1111/pace.12687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/26/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- LU CHEN
- Division of Cardiology, Department of Medicine; University of California; San Diego California
| | - HAIXIA FU
- Department of Cardiovascular Diseases; Henan Provincial People's Hospital, Zhengzhou University; Henan China
- Department of Cardiovascular Diseases; Mayo Clinics; Rochester Minnesota
| | - VICTOR G. PRETORIUS
- Department of Surgery, Division of Cardiothoracic Surgery; University of California; San Diego California
| | - DACHUN YANG
- Department of Cardiovascular Diseases; Mayo Clinics; Rochester Minnesota
| | - HEATHER J. WISTE
- Department of Health Science Research; Mayo Clinics; Rochester Minnesota
| | - HONGTAO YUAN
- Department of Cardiovascular Diseases; Mayo Clinics; Rochester Minnesota
| | - GREGORY K. FELD
- Division of Cardiology, Department of Medicine; University of California; San Diego California
| | - YONG-MEI CHA
- Department of Cardiovascular Diseases; Mayo Clinics; Rochester Minnesota
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Stirrat J, Joncas SX, Salerno M, Drangova M, White J. Influence of phase correction of late gadolinium enhancement images on scar signal quantification in patients with ischemic and non-ischemic cardiomyopathy. J Cardiovasc Magn Reson 2015; 17:66. [PMID: 26248535 PMCID: PMC4528363 DOI: 10.1186/s12968-015-0163-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/24/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Myocardial fibrosis imaging using late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) has been validated as a quantitative predictive marker for response to medical, surgical, and device therapy. To date, all such studies have examined conventional, non-phase corrected magnitude images. However, contemporary practice has rapdily adopted phase-corrected image reconstruction. We sought to investigate the existence of any systematic bias between threshold-based scar quantification performed on conventional magnitude inversion recovery (MIR) and matched phase sensitive inversion recovery (PSIR) images. METHODS In 80 patients with confirmed ischemic (N = 40), or non-ischemic (n = 40) myocardial fibrosis, and also in a healthy control cohort (N = 40) without fibrosis, myocardial late enhancement was quantified using a Signal Threshold Versus Reference Myocardium technique (STRM) at ≥2, ≥3, and ≥5 SD threshold, and also using the Full Width at Half Maximal (FWHM) technique. This was performed on both MIR and PSIR images and values compared using linear regression and Bland-Altman analyses. RESULTS Linear regression analysis demonstrated excellent correlation for scar volumes between MIR and PSIR images at all three STRM signal thresholds for the ischemic (N = 40, r = 0.96, 0.95, 0.88 at 2, 3, and 5 SD, p < 0.0001 for all regressions), and non ischemic (N = 40, r = 0.86, 0.89, 0.90 at 2, 3, and 5 SD, p < 0.0001 for all regressions) cohorts. FWHM analysis demonstrated good correlation in the ischemic population (N = 40, r = 0.83, p < 0.0001). Bland-Altman analysis demonstrated a systematic bias with MIR images showing higher values than PSIR for ischemic (3.3 %, 3.9 % and 4.9 % at 2, 3, and 5 SD, respectively), and non-ischemic (9.7 %, 7.4 % and 4.1 % at ≥2, ≥3, and ≥5 SD thresholds, respectively) cohorts. Background myocardial signal measured in the control population demonstrated a similar bias of 4.4 %, 2.6 % and 0.7 % of the LV volume at 2, 3 and 5 SD thresholds, respectively. The bias observed using FWHM analysis was -6.9 %. CONCLUSIONS Scar quantification using phase corrected (PSIR) images achieves values highly correlated to those obtained on non-corrected (MIR) images. However, a systematic bias exists that appears exaggerated in non-ischemic cohorts. Such bias should be considered when comparing or translating knowledge between MIR- and PSIR-based imaging.
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Affiliation(s)
- John Stirrat
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.
| | - Sebastien Xavier Joncas
- Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Michael Salerno
- Departments of Medicine, Radiology, and Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
| | - Maria Drangova
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - James White
- Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
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OSWALD HANNO, ASBACH STEFAN, KÖBE JULIA, WEGLAGE HEINRICH, SCHULTE-PITZKE BERNFRIED, BRACHMANN JOHANNES. Effectiveness and Reliability of Selected Site Pacing for Avoidance of Phrenic Nerve Stimulation in CRT Patients with Quadripolar LV Leads: The EffaceQ Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:942-50. [DOI: 10.1111/pace.12664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 12/13/2022]
Affiliation(s)
- HANNO OSWALD
- Department of Cardiology and Angiology; Hannover Medical School; Hannover Germany
| | | | - JULIA KÖBE
- Münster University Hospital; Münster Germany
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Levine A, Hecht HS. Cardiac CT Angiography in Congestive Heart Failure. J Nucl Med 2015; 56 Suppl 4:46S-51S. [DOI: 10.2967/jnumed.114.150441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Xia X, Wieslander B, Strauss DG, Wagner GS, Zareba W, Moss AJ, Couderc JP. Automatic QRS Selvester scoring system in patients with left bundle branch block. Europace 2015; 18:308-14. [DOI: 10.1093/europace/euv040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 01/25/2015] [Indexed: 11/14/2022] Open
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Laksman Z, Yee R, Stirrat J, Gula LJ, Skanes AC, Leong-Sit P, Manlucu J, McCarty D, Turkistani Y, Scholl D, Rajchl M, Goela A, Islam A, Thompson RT, Drangova M, White JA. Model-based navigation of left and right ventricular leads to optimal targets for cardiac resynchronization therapy: a single-center feasibility study. Circ Arrhythm Electrophysiol 2014; 7:1040-7. [PMID: 25221334 DOI: 10.1161/circep.114.001729] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Left ventricular (LV) and right ventricular pacing site characteristics have been shown to influence response to cardiac resynchronization therapy (CRT). This study aimed to determine the clinical feasibility of image-guided lead delivery using a 3-dimensional navigational model displaying both LV and right ventricular (RV) pacing targets. Serial echocardiographic measures of clinical response and procedural metrics were evaluated. METHODS AND RESULTS Thirty-one consecutive patients underwent preimplant cardiac MRI with the generation of a 3-dimensional navigational model depicting optimal segmental targets for LV and RV leads. Lead delivery was guided by the model in matched views to intraprocedural fluoroscopy. Blinded assessment of final lead tip location was performed from postprocedural cardiac computed tomography. Clinical and LV remodeling response criteria were assessed at baseline, 3 months, and 6 months using a 6-minute hall walk, quality of life questionnaire, and echocardiography. Mean age and LV ejection fraction was 66 ± 8 years and 26 ± 8%, respectively. LV leads were successfully delivered to a target or adjacent segment in 30 of 31 patients (97%), 68% being nonposterolateral. RV leads were delivered to a target or adjacent segment in 30 of 31 patients (97%), 26% being nonapical. Twenty-three patients (74%) met standard criteria for response (LV end-systolic volume reduction ≥ 15%), 18 patients (58%) for super-response (LV end-systolic volume reduction ≥ 30%). LV ejection fraction improved at 6 months (31 ± 8 versus 26 ± 8%, P=0.04). CONCLUSIONS This study demonstrates clinical feasibility of dual cardiac resynchronization therapy lead delivery to optimal targets using a 3-dimensional navigational model. High procedural success, acceptable procedural times, and a low rate of early procedural complications were observed. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01640769.
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Affiliation(s)
- Zachary Laksman
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Raymond Yee
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - John Stirrat
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Lorne J Gula
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Allan C Skanes
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Peter Leong-Sit
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Jamie Manlucu
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - David McCarty
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Yosra Turkistani
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - David Scholl
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Martin Rajchl
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Aashish Goela
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Ali Islam
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - R Terry Thompson
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Maria Drangova
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - James A White
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.).
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Leyva F, Nisam S, Auricchio A. 20 Years of Cardiac Resynchronization Therapy. J Am Coll Cardiol 2014; 64:1047-58. [DOI: 10.1016/j.jacc.2014.06.1178] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/15/2014] [Accepted: 06/17/2014] [Indexed: 01/14/2023]
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