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Usefulness of Myocardial Strain and Twist for Early Detection of Myocardial Dysfunction in Patients With Autoimmune Diseases. Am J Cardiol 2020; 125:475-481. [PMID: 31784053 DOI: 10.1016/j.amjcard.2019.10.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/26/2019] [Accepted: 10/30/2019] [Indexed: 12/23/2022]
Abstract
Cardiac involvement in autoimmune diseases (AD) is common but underdiagnosed due to a lack of sensitive imaging methods. We aim to evaluate the characteristics of left ventricular (LV) systolic dysfunction in patients with AD using deformational parameters from 2-dimensional speckle-tracking echocardiography (STE). We retrospectively enrolled 86 AD patients and 71 healthy controls. All subjects underwent transthoracic echocardiography and STE to analyze LV strain and twist. A twist-radial displacement loop was constructed to investigate the relation between LV contractility and dimension. In AD patients, 68 had preserved LV ejection fraction (EF ≥ 50%), and 18 had reduced LVEF (EF < 50%). The patients with preserved LVEF exhibited significantly lower values of global longitudinal, circumferential, and radial strain than controls (-19.11 ± 4.18 vs -21.49 ± 2.53%, -25.17 ± 5.04% vs -27.37 ± 2.87%, 17.68 ± 5.69% vs 21.17 ± 6.44%, respectively; all p <0.01) and a marked attenuation in peak twist (14.24 ± 5.57 vs 18.10 ± 5.97, p <0.01) attributed to impaired apical rotation (9.03 ± 5.17 vs 12.79 ± 5.99, p <0.01). AD patients were more likely to present with abnormal loop types with flat ascending slope and delayed peak twist time. In conclusion, abnormal strain and twist precede deterioration in LVEF, suggesting early myocardial involvement in AD. STE can be used as a good alternative for early detection of myocardial dysfunction in AD patients.
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Dal Ferro M, De Paris V, Collia D, Stolfo D, Caiffa T, Barbati G, Korcova R, Pinamonti B, Zovatto L, Zecchin M, Sinagra G, Pedrizzetti G. Left Ventricular Response to Cardiac Resynchronization Therapy: Insights From Hemodynamic Forces Computed by Speckle Tracking. Front Cardiovasc Med 2019; 6:59. [PMID: 31139633 PMCID: PMC6527774 DOI: 10.3389/fcvm.2019.00059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
Aims: Despite continuous efforts in improving the selection process, the rate of non-responders to cardiac resynchronization therapy (CRT) remains high. Recent studies on intraventricular blood flow suggested that the alignment of hemodynamic forces (HDFs) may be a reproducible biomarker of mechanical dyssynchrony. We aimed to explore the relationship between pacing-induced realignment of HDFs and positive response to CRT. Methods and results: We retrospectively analyzed 38 patients from the CRT database of our institution fulfilling the inclusion criteria for HDFs-related echocardiographic assessment early pre and post CRT implantation, with available mid-term follow-up (≥ 6 months) evaluation. Standard echocardiographic and deformation parameters early pre and post CRT implantation were integrated with the measurement of HFDs through novel methods based on speckle-tracking analysis. At midterm follow-up 71% of patients were classified as responders (reduction of Left Ventricular Systolic Volume Indexed ≥ 15%). Patients did not display significant changes between close evaluations pre and post-implant in terms of ejection fraction and strain metrics. A significant reduction of the ratio between the amplitudes of transversal and longitudinal force components was found. The variation of this ratio strongly correlates (R2 =0.60) with Left Ventricular (LV) end-systolic volume variation at mid-term follow up. Conclusion: Pacing-induced realignment of HDFs is associated with CRT efficacy at follow up. These preliminary results claim for dedicated prospective clinical studies testing the potential impact of HDFs study for patient selection and pacing optimization in CRT.
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Affiliation(s)
- Matteo Dal Ferro
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Valerio De Paris
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Dario Collia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Thomas Caiffa
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Renata Korcova
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Bruno Pinamonti
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Luigino Zovatto
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
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Duration of reverse remodeling response to cardiac resynchronization therapy: Rates, predictors, and clinical outcomes. Int J Cardiol 2017; 243:340-346. [DOI: 10.1016/j.ijcard.2017.05.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/15/2017] [Accepted: 05/11/2017] [Indexed: 11/19/2022]
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Qiu Q, Yang L, Mai JT, Yang Y, Xie Y, Chen YX, Wang JF. Acute Effects of Multisite Biventricular Pacing on Dyssynchrony and Hemodynamics in Canines With Heart Failure. J Card Fail 2017; 23:304-311. [DOI: 10.1016/j.cardfail.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 12/13/2016] [Accepted: 01/09/2017] [Indexed: 01/14/2023]
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Abstract
Dyssynchronous contraction of the ventricle significantly worsens morbidity and mortality in patients with heart failure (HF). Approximately one-third of patients with HF have cardiac dyssynchrony and are candidates for cardiac resynchronization therapy (CRT). The initial understanding of dyssynchrony and CRT was in terms of global mechanics and hemodynamics, but lack of clinical benefit in a sizable subgroup of recipients who appear otherwise appropriate has challenged this paradigm. This article reviews current understanding of these cellular and subcellular mechanisms, arguing that these aspects are key to improving CRT use, as well as translating its benefits to a wider HF population.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA.
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA
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Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E. Tissue Tracking Technology for Assessing Cardiac Mechanics: Principles, Normal Values, and Clinical Applications. JACC Cardiovasc Imaging 2016; 8:1444-1460. [PMID: 26699113 DOI: 10.1016/j.jcmg.2015.11.001] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
Tissue tracking technologies such as speckle tracking echocardiography and feature tracking cardiac magnetic resonance have enhanced the noninvasive assessment of myocardial deformation in clinical research and clinical practice. The widespread enthusiasm for using tissue tracking techniques in research and clinical practice stems from the ready applicability of these technologies to routine echocardiographic or cardiac magnetic resonance images. The technology is common to both modalities, and derived parameters to describe myocardial mechanics are the similar, albeit with different accuracies. We provide an overview of the normal values and reproducibility of the clinically applicable parameters, together with their clinical validation. The use of these technologies in different clinical scenarios, and the additive value to current imaging diagnostics are discussed.
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Affiliation(s)
- Piet Claus
- Laboratory for Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alaa Mabrouk Salem Omar
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Medical Division, National Research Centre, Dokki, Cairo, Egypt
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Partho P Sengupta
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eike Nagel
- Institute of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research ([DZHK], partner site Rhine-Main), Frankfurt, Germany.
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Marek J, Gandalovičová J, Kejřová E, Pšenička M, Linhart A, Paleček T. Echocardiography and cardiac resynchronization therapy. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pedrizzetti G, Martiniello AR, Bianchi V, D'Onofrio A, Caso P, Tonti G. Changes in electrical activation modify the orientation of left ventricular flow momentum: novel observations using echocardiographic particle image velocimetry. Eur Heart J Cardiovasc Imaging 2016; 17:203-9. [PMID: 26060201 PMCID: PMC4882880 DOI: 10.1093/ehjci/jev137] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIMS Changes in electrical activation sequence are known to affect the timing of cardiac mechanical events. We aim to demonstrate that these also modify global properties of the intraventricular blood flow pattern. We also explore whether such global changes present a relationship with clinical outcome. METHODS AND RESULTS We investigated 30 heart failure patients followed up after cardiac resynchronization therapy (CRT). All subjects underwent echocardiography before implant and at follow-up after 6+ months. Left ventricular mechanics was investigated at follow-up during active CRT and was repeated after a temporary interruption <5 min later. Strain analysis, performed by speckle tracking, was used to assess the entity of contraction (global longitudinal strain) and its synchronicity (standard deviation of time to peak of radial strain). Intraventricular fluid dynamics, by echographic particle image velocimetry, was used to evaluate the directional distribution of global momentum associated with blood motion. The discontinuation of CRT pacing reflects into a reduction of deformation synchrony and into the deviation of blood flow momentum from the base-apex orientation with the development of transversal flow-mediated haemodynamic forces. The deviation of flow momentum presents a significant correlation with the degree of volumetric reduction after CRT. CONCLUSION Changes in electrical activation alter the orientation of blood flow momentum. The long-term CRT outcome correlates with the degree of re-alignment of haemodynamic forces. These preliminary results suggest that flow orientation could be used for optimizing the biventricular pacing setting. However, larger prospective studies are needed to confirm this hypothesis.
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Affiliation(s)
- Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, P.le Europa 1., Trieste 34127, Italy
| | | | - Valter Bianchi
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Antonio D'Onofrio
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Pio Caso
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Giovanni Tonti
- Cardiology Division, 'G. d'Annunzio' University, Chieti, Italy
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Abstract
Dyssynchronous contraction of the ventricle significantly worsens morbidity and mortality in patients with heart failure (HF). Approximately one-third of patients with HF have cardiac dyssynchrony and are candidates for cardiac resynchronization therapy (CRT). The initial understanding of dyssynchrony and CRT was in terms of global mechanics and hemodynamics, but lack of clinical benefit in a sizable subgroup of recipients who appear otherwise appropriate has challenged this paradigm. This article reviews current understanding of these cellular and subcellular mechanisms, arguing that these aspects are key to improving CRT use, as well as translating its benefits to a wider HF population.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA.
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA
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Lumens J, Tayal B, Walmsley J, Delgado-Montero A, Huntjens PR, Schwartzman D, Althouse AD, Delhaas T, Prinzen FW, Gorcsan J. Differentiating Electromechanical From Non-Electrical Substrates of Mechanical Discoordination to Identify Responders to Cardiac Resynchronization Therapy. Circ Cardiovasc Imaging 2015; 8:e003744. [PMID: 26338877 DOI: 10.1161/circimaging.115.003744] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular (LV) mechanical discoordination, often referred to as dyssynchrony, is often observed in patients with heart failure regardless of QRS duration. We hypothesized that different myocardial substrates for LV mechanical discoordination exist from (1) electromechanical activation delay, (2) regional differences in contractility, or (3) regional scar and that we could differentiate electromechanical substrates responsive to cardiac resynchronization therapy (CRT) from unresponsive non-electrical substrates. METHODS AND RESULTS First, we used computer simulations to characterize mechanical discoordination patterns arising from electromechanical and non-electrical substrates and accordingly devise the novel systolic stretch index (SSI), as the sum of posterolateral systolic prestretch and septal systolic rebound stretch. Second, 191 patients with heart failure (QRS duration ≥120 ms; LV ejection fraction ≤35%) had baseline SSI quantified by automated echocardiographic radial strain analysis. Patients with SSI≥9.7% had significantly less heart failure hospitalizations or deaths 2 years after CRT (hazard ratio, 0.32; 95% confidence interval, 0.19-0.53; P<0.001) and less deaths, transplants, or LV assist devices (hazard ratio, 0.28; 95% confidence interval, 0.15-0.55; P<0.001). Furthermore, in a subgroup of 113 patients with intermediate electrocardiographic criteria (QRS duration of 120-149 ms or non-left bundle branch block), SSI≥9.7% was independently associated with significantly less heart failure hospitalizations or deaths (hazard ratio, 0.41; 95% confidence interval, 0.23-0.79; P=0.004) and less deaths, transplants, or LV assist devices (hazard ratio, 0.27; 95% confidence interval, 0.12-0.60; P=0.001). CONCLUSIONS Computer simulations differentiated patterns of LV mechanical discoordination caused by electromechanical substrates responsive to CRT from those related to regional hypocontractility or scar unresponsive to CRT. The novel SSI identified patients who benefited more favorably from CRT, including those with intermediate electrocardiographic criteria, where CRT response is less certain by ECG alone.
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Affiliation(s)
- Joost Lumens
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.).
| | - Bhupendar Tayal
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - John Walmsley
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Antonia Delgado-Montero
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Peter R Huntjens
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - David Schwartzman
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Andrew D Althouse
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Tammo Delhaas
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Frits W Prinzen
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - John Gorcsan
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
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Opdahl A, Helle-Valle T, Skulstad H, Smiseth OA. Strain, Strain Rate, Torsion, and Twist: Echocardiographic Evaluation. Curr Cardiol Rep 2015; 17:568. [DOI: 10.1007/s11886-015-0568-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Kydd AC, Khan FZ, Ring L, Pugh PJ, Virdee MS, Dutka DP. Development of a multiparametric score to predict left ventricular remodelling and prognosis after cardiac resynchronization therapy. Eur J Heart Fail 2014; 16:1206-13. [PMID: 25302484 DOI: 10.1002/ejhf.167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 11/08/2022] Open
Abstract
AIMS Optimal delivery of CRT requires appropriate patient selection and device implantation. Echocardiographic predictors of CRT response individually appear to enhance patient selection, but do not fully reflect the complex underlying myocardial dysfunction. We hypothesized that a multiparametric approach would offer greater predictive value and sought to derive a score incorporating baseline characteristics including: dyssynchrony, LV function, and LV lead position. METHODS AND RESULTS Data were analysed from 294 patients undergoing CRT between June 2008 and December 2012. All patients were in sinus rhythm with QRS >120 ms, NYHA class II-IV, and LVEF <35%. Detailed clinical assessment including echocardiography was completed at baseline and 6 months after CRT. Response was defined as a ≥15% reduction in LV end-systolic volume. Dyssynchrony (interventricular delay and radial strain delay), global longitudinal strain, and LV lead position were independent predictors of LV remodelling and were used to derive a predictive score which correlated with reduction in LV volume (r = - 0.5, P < 0.001) and was higher with QRS >150 ms and non-ischaemic aetiology. A cut-off score <0.6 offered the highest specificity and positive predictive value (100%) to determine non-response. A score >3.28 offered high specificity (specificity 86%, sensitivity 70%) to predict response. Survival proportion at longer term follow-up was low (21%) in the group with predictive score <0.6. CONCLUSION A multiparametric strategy, which defines anticipated probability of response to CRT, offers potential to predict non-responders with poor long-term survival following CRT. The value of this approach in avoiding unnecessary device implantation with potential for harm requires validation in large multicentre studies.
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Affiliation(s)
- Anna C Kydd
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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13
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Myocardial motion and deformation patterns in an experimental swine model of acute LBBB/CRT and chronic infarct. Int J Cardiovasc Imaging 2014; 30:875-87. [DOI: 10.1007/s10554-014-0403-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
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Abstract
Patients with heart failure and decreased function frequently develop discoordinate contraction because of electric activation delay. Often termed dyssynchrony, this further decreases systolic function and chamber efficiency and worsens morbidity and mortality. In the mid- 1990s, a pacemaker-based treatment termed cardiac resynchronization therapy (CRT) was developed to restore mechanical synchrony by electrically activating both right and left sides of the heart. It is a major therapeutic advance for the new millennium. Acute chamber effects of CRT include increased cardiac output and mechanical efficiency and reduced mitral regurgitation, whereas reduction in chamber volumes ensues more chronically. Patient candidates for CRT have a prolonged QRS duration and discoordinate wall motion, although other factors may also be important because ≈30% of such selected subjects do not respond to the treatment. In contrast to existing pharmacological inotropes, CRT both acutely and chronically increases cardiac systolic function and work, yet it also reduces long-term mortality. Recent studies reveal unique molecular and cellular changes from CRT that may also contribute to this success. Heart failure with dyssynchrony displays decreased myocyte and myofilament function, calcium handling, β-adrenergic responsiveness, mitochondrial ATP synthase activity, cell survival signaling, and other changes. CRT reverses many of these abnormalities often by triggering entirely new pathways. In this review, we discuss chamber, circulatory, and basic myocardial effects of dyssynchrony and CRT in the failing heart, and we highlight new research aiming to better target and implement CRT, as well as leverage its molecular effects.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Oh JK, Vatury OM, Wang CL. Identification of Wasted Energy Is a Key to Predict Positive Response to Cardiac Resynchronization Therapy. Circ Cardiovasc Imaging 2013; 6:159-61. [DOI: 10.1161/circimaging.113.000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jae K. Oh
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., O.V.); and the First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-L.W.)
| | - Ori M. Vatury
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., O.V.); and the First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-L.W.)
| | - Chun-Li Wang
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., O.V.); and the First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-L.W.)
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