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Zhang Z, Xiao Y, Dai Y, Lin Q, Liu Q. Device therapy for patients with atrial fibrillation and heart failure with preserved ejection fraction. Heart Fail Rev 2024; 29:417-430. [PMID: 37940727 PMCID: PMC10943171 DOI: 10.1007/s10741-023-10366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
Device therapy is a nonpharmacological approach that presents a crucial advancement for managing patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). This review investigated the impact of device-based interventions and emphasized their potential for optimizing treatment for this complex patient demographic. Cardiac resynchronization therapy, augmented by atrioventricular node ablation with His-bundle pacing or left bundle-branch pacing, is effective for enhancing cardiac function and establishing atrioventricular synchrony. Cardiac contractility modulation and vagus nerve stimulation represent novel strategies for increasing myocardial contractility and adjusting the autonomic balance. Left ventricular expanders have demonstrated short-term benefits in HFpEF patients but require more investigation for long-term effectiveness and safety, especially in patients with AF. Research gaps regarding complications arising from left ventricular expander implantation need to be addressed. Device-based therapies for heart valve diseases, such as transcatheter aortic valve replacement and transcatheter edge-to-edge repair, show promise for patients with AF and HFpEF, particularly those with mitral or tricuspid regurgitation. Clinical evaluations show that these device therapies lessen AF occurrence, improve exercise tolerance, and boost left ventricular diastolic function. However, additional studies are required to perfect patient selection criteria and ascertain the long-term effectiveness and safety of these interventions. Our review underscores the significant potential of device therapy for improving the outcomes and quality of life for patients with AF and HFpEF.
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Affiliation(s)
- Zixi Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China.
| | - Yongguo Dai
- Department of Pharmacology, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, 430071, Hubei Province, People's Republic of China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China
| | - Qiming Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China.
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Tokmak F, Koivisto T, Lahdenoja O, Vasankari T, Jaakkola S, Airaksinen KEJ. Mechanocardiography detects improvement of systolic function caused by resynchronization pacing. Physiol Meas 2023; 44:125009. [PMID: 38041869 DOI: 10.1088/1361-6579/ad1197] [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: 06/16/2023] [Accepted: 12/01/2023] [Indexed: 12/04/2023]
Abstract
Objective.Cardiac resynchronization therapy (CRT) is commonly used to manage heart failure with dyssynchronous ventricular contraction. CRT pacing resynchronizes the ventricular contraction, while AAI (single-chamber atrial) pacing does not affect the dyssynchronous function. This study compared waveform characteristics during CRT and AAI pacing at similar pacing rates using seismocardiogram (SCG) and gyrocardiogram (GCG), collectively known as mechanocardiogram (MCG).Approach.We included 10 patients with heart failure with reduced ejection fraction and previously implanted CRT pacemakers. ECG and MCG recordings were taken during AAI and CRT pacing at a heart rate of 80 bpm. Waveform characteristics, including energy, vertical range (amplitude) during systole and early diastole, electromechanical systole (QS2) and left ventricular ejection time (LVET), were derived by considering 6 MCG axes and 3 MCG vectors across frequency ranges of >1 Hz, 20-90 Hz, 6-90 Hz and 1-20 Hz.Main results.Significant differences were observed between CRT and AAI pacing. CRT pacing consistently exhibited higher energy and vertical range during systole compared to AAI pacing (p< 0.05). However, QS2, LVET and waveform characteristics around aortic valve closure did not differ between the pacing modes. Optimal differences were observed in SCG-Y, GCG-X, and GCG-Y axes within the frequency range of 6-90 Hz.Significance.The results demonstrate significant differences in MCG waveforms, reflecting improved mechanical cardiac function during CRT. This information has potential implications for predicting the clinical response to CRT. Further research is needed to explore the differences in signal characteristics between responders and non-responders to CRT.
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Affiliation(s)
- Fadime Tokmak
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Tero Koivisto
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Olli Lahdenoja
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, Hämeentie 11, FI-20520 Turku, Finland
| | - Samuli Jaakkola
- Heart Center, Turku University Hospital, Hämeentie 11, FI-20520 Turku, Finland
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Arvidsson PM, Green PG, Watson WD, Shanmuganathan M, Heiberg E, De Maria GL, Arheden H, Herring N, Rider OJ. Non-invasive left ventricular pressure-volume loops from cardiovascular magnetic resonance imaging and brachial blood pressure: validation using pressure catheter measurements. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad035. [PMID: 37969333 PMCID: PMC10631830 DOI: 10.1093/ehjimp/qyad035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023]
Abstract
Aims Left ventricular (LV) pressure-volume (PV) loops provide gold-standard physiological information but require invasive measurements of ventricular intracavity pressure, limiting clinical and research applications. A non-invasive method for the computation of PV loops from magnetic resonance imaging and brachial cuff blood pressure has recently been proposed. Here we evaluated the fidelity of the non-invasive PV algorithm against invasive LV pressures in humans. Methods and results Four heart failure patients with EF < 35% and LV dyssynchrony underwent cardiovascular magnetic resonance (CMR) imaging and subsequent LV catheterization with sequential administration of two different intravenous metabolic substrate infusions (insulin/dextrose and lipid emulsion), producing eight datasets at different haemodynamic states. Pressure-volume loops were computed from CMR volumes combined with (i) a time-varying elastance function scaled to brachial blood pressure and temporally stretched to match volume data, or (ii) invasive pressures averaged from 19 to 30 sampled beats. Method comparison was conducted using linear regression and Bland-Altman analysis. Non-invasively derived PV loop parameters demonstrated high correlation and low bias when compared to invasive data for stroke work (R2 = 0.96, P < 0.0001, bias 4.6%), potential energy (R2 = 0.83, P = 0.001, bias 1.5%), end-systolic pressure-volume relationship (R2 = 0.89, P = 0.0004, bias 5.8%), ventricular efficiency (R2 = 0.98, P < 0.0001, bias 0.8%), arterial elastance (R2 = 0.88, P = 0.0006, bias -8.0%), mean external power (R2 = 0.92, P = 0.0002, bias 4.4%), and energy per ejected volume (R2 = 0.89, P = 0.0001, bias 3.7%). Variations in estimated end-diastolic pressure did not significantly affect results (P > 0.05 for all). Intraobserver analysis after one year demonstrated 0.9-3.4% bias for LV volumetry and 0.2-5.4% for PV loop-derived parameters. Conclusion Pressure-volume loops can be precisely and accurately computed from CMR imaging and brachial cuff blood pressure in humans.
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Affiliation(s)
- Per M Arvidsson
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Peregrine G Green
- Oxford Heart Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - William D Watson
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
- Department of Cardiovascular Medicine, Heart and Lung Research Institute, Papworth Road, Cambridge CB2 0AY, United Kingdom
| | - Mayooran Shanmuganathan
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
- Cardiology Department, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, Queen Alexandra Road, High Wycombe HP11 2TT, United Kingdom
- Heart Transplant Department, Harefield Hospital, Royal Brompton and Harefield Hospitals, Hill End Road, Harefield UB9 6JH, United Kingdom
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - Oliver J Rider
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
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Monge García MI, Jian Z, Hatib F, Settles JJ, Cecconi M, Pinsky MR. Relationship between intraventricular mechanical dyssynchrony and left ventricular systolic and diastolic performance: An in vivo experimental study. Physiol Rep 2023; 11:e15607. [PMID: 36808901 PMCID: PMC9937795 DOI: 10.14814/phy2.15607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
Left ventricular mechanical dyssynchrony (LVMD) refers to the nonuniformity in mechanical contraction and relaxation timing in different ventricular segments. We aimed to determine the relationship between LVMD and LV performance, as assessed by ventriculo-arterial coupling (VAC), LV mechanical efficiency (LVeff ), left ventricular ejection fraction (LVEF), and diastolic function during sequential experimental changes in loading and contractile conditions. Thirteen Yorkshire pigs submitted to three consecutive stages with two opposite interventions each: changes in afterload (phenylephrine/nitroprusside), preload (bleeding/reinfusion and fluid bolus), and contractility (esmolol/dobutamine). LV pressure-volume data were obtained with a conductance catheter. Segmental mechanical dyssynchrony was assessed by global, systolic, and diastolic dyssynchrony (DYS) and internal flow fraction (IFF). Late systolic LVMD was related to an impaired VAC, LVeff , and LVEF, whereas diastolic LVMD was associated with delayed LV relaxation (logistic tau), decreased LV peak filling rate, and increased atrial contribution to LV filling. The hemodynamic factors related to LVMD were contractility, afterload, and heart rate. However, the relationship between these factors differed throughout the cardiac cycle. LVMD plays a significant role in LV systolic and diastolic performance and is associated with hemodynamic factors and intraventricular conduction.
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Affiliation(s)
| | | | | | | | - Maurizio Cecconi
- Department Anaesthesia and Intensive Care Units, Humanitas Research HospitalHumanitas UniversityMilanItaly
| | - Michael R. Pinsky
- Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
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5
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Bivona DJ, Tallavajhala S, Abdi M, Oomen PJA, Gao X, Malhotra R, Darby A, Monfredi OJ, Mangrum JM, Mason P, Mazimba S, Salerno M, Kramer CM, Epstein FH, Holmes JW, Bilchick KC. Cardiac magnetic resonance defines mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy. Front Cardiovasc Med 2022; 9:1007806. [PMID: 36186999 PMCID: PMC9521735 DOI: 10.3389/fcvm.2022.1007806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mechanisms of sex-based differences in outcomes following cardiac resynchronization therapy (CRT) are poorly understood. Objective To use cardiac magnetic resonance (CMR) to define mechanisms of sex-based differences in outcomes after CRT and describe distinct CMR-based phenotypes of CRT candidates based on sex and non-ischemic/ischemic cardiomyopathy type. Materials and methods In a prospective study, sex-based differences in three short-term CRT response measures [fractional change in left ventricular end-systolic volume index 6 months after CRT (LVESVI-FC), B-type natriuretic peptide (BNP) 6 months after CRT, change in peak VO2 6 months after CRT], and long-term survival were evaluated with respect to 39 baseline parameters from CMR, exercise testing, laboratory testing, electrocardiograms, comorbid conditions, and other sources. CMR was also used to quantify the degree of left-ventricular mechanical dyssynchrony by deriving the circumferential uniformity ratio estimate (CURE-SVD) parameter from displacement encoding with stimulated echoes (DENSE) strain imaging. Statistical methods included multivariable linear regression with evaluation of interaction effects associated with sex and cardiomyopathy type (ischemic and non-ischemic cardiomyopathy) and survival analysis. Results Among 200 patients, the 54 female patients (27%) pre-CRT had a smaller CMR-based LVEDVI (p = 0.04), more mechanical dyssynchrony based on the validated CMR CURE-SVD parameter (p = 0.04), a lower frequency of both late gadolinium enhancement (LGE) and ischemic cardiomyopathy (p < 0.0001), a greater RVEF (p = 0.02), and a greater frequency of LBBB (p = 0.01). After categorization of patients into four groups based on cardiomyopathy type (ischemic/non-ischemic cardiomyopathy) and sex, female patients with non-ischemic cardiomyopathy had the lowest CURE-SVD (p = 0.003), the lowest pre-CRT BNP levels (p = 0.01), the lowest post-CRT BNP levels (p = 0.05), and the most favorable LVESVI-FC (p = 0.001). Overall, female patients had better 3-year survival before adjustment for cardiomyopathy type (p = 0.007, HR = 0.45) and after adjustment for cardiomyopathy type (p = 0.009, HR = 0.67). Conclusion CMR identifies distinct phenotypes of female CRT patients with non-ischemic and ischemic cardiomyopathy relative to male patients stratified by cardiomyopathy type. The more favorable short-term response and long-term survival outcomes in female heart failure patients with CRT were associated with lower indexed CMR-based LV volumes, decreased presence of scar associated with prior myocardial infarction and ICM, and greater CMR-based dyssynchrony with the CURE-SVD.
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Affiliation(s)
- Derek J. Bivona
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Srikar Tallavajhala
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Pim J. A. Oomen
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | - Xu Gao
- Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Oliver J. Monfredi
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - J. Michael Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Pamela Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Michael Salerno
- Department of Medicine and Radiology, Stanford University, Palo Alto, CA, United States
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, United States
| | - Jeffrey W. Holmes
- Department of Medicine, Surgery, and Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kenneth C. Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
- *Correspondence: Kenneth C. Bilchick,
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6
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Yin MY, Tandar A, Sharma V, Glotzbach JP, Shah RU, Dranow E, Tseliou E, Fang JC, Drakos SG, Welt FGP. Left Ventricular Hemodynamic Changes During Transcatheter Aortic Valve Replacement Assessed by Real-Time Pressure-Volume Loops. JACC Cardiovasc Interv 2021; 13:2190-2192. [PMID: 32972584 DOI: 10.1016/j.jcin.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/18/2020] [Accepted: 04/07/2020] [Indexed: 11/27/2022]
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Patterson T, Rivolo S, Burkhoff D, Schreuder J, Briceno N, Williams R, Arri S, Asrress KN, Allen C, Joseph J, McConkey HZR, Ellis H, Pavlidis A, Clapp B, Perera D, Lee J, Marber MS, Redwood SR. Impact of coronary artery disease on contractile function and ventricular-arterial coupling during exercise: Simultaneous assessment of left-ventricular pressure-volume and coronary pressure and flow during cardiac catheterization. Physiol Rep 2021; 9:e14768. [PMID: 34042307 PMCID: PMC8157768 DOI: 10.14814/phy2.14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 01/09/2023] Open
Abstract
Coronary artery disease (CAD) can adversely affect left ventricular (LV) performance during exercise by impairment of contractile function in the presence of increasing afterload. By performing invasive measures of LV pressure–volume and coronary pressure and flow during exercise, we sought to accurately measure this with comparison to the control group. Sixteen patients, with CCS class >II angina and CAD underwent invasive simultaneous measurement of left ventricular pressure–volume and coronary pressure and flow velocity during cardiac catheterization. Measurements performed at rest were compared with peak exercise using bicycle ergometry. The LV contractile function was measured invasively using the end‐systolic pressure–volume relationship, a load independent marker of contractile function (Ees). Vascular afterload forces were derived from the ratio of LV end‐systolic pressure to stroke volume to generate arterial elastance (Ea). These were combined to assess cardiovascular performance (ventricular‐arterial [VA] coupling ratio [Ea/Ees]). Eleven patients demonstrated flow‐limiting (FL) CAD (hyperemic Pd/Pa <0.80; ST‐segment depression on exercise); five patients without flow‐limiting (NFL) CAD served as the control group. Exercise in the presence of FL CAD was associated impairment of Ees, increased Ea, and deterioration of VA coupling. In the control cohort, exercise was associated with increased Ees and improved VA coupling. The backward compression wave energy directly correlated with the magnitude contraction as measured by dP/dTmax (r = 0.88, p = 0.004). This study demonstrates that in the presence of flow‐limiting CAD, exercise to maximal effort can lead to impairment of LV contractile function and a deterioration in VA coupling compared to a control cohort.
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Affiliation(s)
- Tiffany Patterson
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Simone Rivolo
- Department of Imaging Science, King's College London, St. Thomas' Hospital, London, UK
| | | | - Jan Schreuder
- CD Leycom, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Natalia Briceno
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Rupert Williams
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Satpal Arri
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Kaleab N Asrress
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Christopher Allen
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Jubin Joseph
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Hannah Z R McConkey
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Howard Ellis
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Antonis Pavlidis
- Cardiothoracic Department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Brian Clapp
- Cardiothoracic Department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Divaka Perera
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Jack Lee
- Department of Imaging Science, King's College London, St. Thomas' Hospital, London, UK
| | - Michael S Marber
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
| | - Simon R Redwood
- Cardiovascular Division, King's College London, St. Thomas' Hospital, London, UK
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Multipoint left ventricular pacing effects on hemodynamic parameters and functional status: HUMVEE single-arm clinical trial (NCT03189368). Hellenic J Cardiol 2021; 63:8-14. [DOI: 10.1016/j.hjc.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/31/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
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Wouters PC, Leenders GE, Cramer MJ, Meine M, Prinzen FW, Doevendans PA, De Boeck BWL. Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy. Int J Cardiovasc Imaging 2021; 37:1903-1911. [PMID: 33547623 PMCID: PMC8255256 DOI: 10.1007/s10554-021-02174-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. METHODS In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. RESULTS CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. CONCLUSION Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.
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Affiliation(s)
- Philippe C Wouters
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Geert E Leenders
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Maarten J Cramer
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Mathias Meine
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Frits W Prinzen
- Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | | | - Bart W L De Boeck
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.,Luzerner Kantonsspital, 6000, Luzern, Switzerland
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10
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Model of Anisotropic Reverse Cardiac Growth in Mechanical Dyssynchrony. Sci Rep 2019; 9:12670. [PMID: 31481725 PMCID: PMC6722088 DOI: 10.1038/s41598-019-48670-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022] Open
Abstract
Based on recent single-cell experiments showing that longitudinal myocyte stretch produces both parallel and serial addition of sarcomeres, we developed an anisotropic growth constitutive model with elastic myofiber stretch as the growth stimuli to simulate long-term changes in biventricular geometry associated with alterations in cardiac electromechanics. The constitutive model is developed based on the volumetric growth framework. In the model, local growth evolutions of the myocyte’s longitudinal and transverse directions are driven by the deviations of maximum elastic myofiber stretch over a cardiac cycle from its corresponding local homeostatic set point, but with different sensitivities. Local homeostatic set point is determined from a simulation with normal activation pattern. The growth constitutive model is coupled to an electromechanics model and calibrated based on both global and local ventricular geometrical changes associated with chronic left ventricular free wall pacing found in previous animal experiments. We show that the coupled electromechanics-growth model can quantitatively reproduce the following: (1) Thinning and thickening of the ventricular wall respectively at early and late activated regions and (2) Global left ventricular dilation as measured in experiments. These findings reinforce the role of elastic myofiber stretch as a growth stimulant at both cellular level and tissue-level.
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11
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Zweerink A, Salden OA, van Everdingen WM, de Roest GJ, van de Ven PM, Cramer MJ, Doevendans PA, van Rossum AC, Vernooy K, Prinzen FW, Meine M, Allaart CP. Hemodynamic Optimization in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2019; 5:1013-1025. [DOI: 10.1016/j.jacep.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 11/16/2022]
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12
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Ikonomidis I, Aboyans V, Blacher J, Brodmann M, Brutsaert DL, Chirinos JA, De Carlo M, Delgado V, Lancellotti P, Lekakis J, Mohty D, Nihoyannopoulos P, Parissis J, Rizzoni D, Ruschitzka F, Seferovic P, Stabile E, Tousoulis D, Vinereanu D, Vlachopoulos C, Vlastos D, Xaplanteris P, Zimlichman R, Metra M. The role of ventricular-arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association. Eur J Heart Fail 2019; 21:402-424. [PMID: 30859669 DOI: 10.1002/ejhf.1436] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
Ventricular-arterial coupling (VAC) plays a major role in the physiology of cardiac and aortic mechanics, as well as in the pathophysiology of cardiac disease. VAC assessment possesses independent diagnostic and prognostic value and may be used to refine riskstratification and monitor therapeutic interventions. Traditionally, VAC is assessed by the non-invasive measurement of the ratio of arterial (Ea) to ventricular end-systolic elastance (Ees). With disease progression, both Ea and Ees may become abnormal and the Ea/Ees ratio may approximate its normal values. Therefore, the measurement of each component of this ratio or of novel more sensitive markers of myocardial (e.g. global longitudinal strain) and arterial function (e.g. pulse wave velocity) may better characterize VAC. In valvular heart disease, systemic arterial compliance and valvulo-arterial impedance have an established diagnostic and prognostic value and may monitor the effects of valve replacement on vascular and cardiac function. Treatment guided to improve VAC through improvement of both or each one of its components may delay incidence of heart failure and possibly improve prognosis in heart failure. In this consensus document, we describe the pathophysiology, the methods of assessment as well as the clinical implications of VAC in cardiac diseases and heart failure. Finally, we focus on interventions that may improve VAC and thus modify prognosis.
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Affiliation(s)
- Ignatios Ikonomidis
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,Inserm 1094, Limoges School of Medicine, Limoges, France
| | - Jacque Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Paris-Descartes University, Hôtel-Dieu Hospital, AP-HP, Paris, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Dirk L Brutsaert
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Julio A Chirinos
- Perelman School of Medicine and Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco De Carlo
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU SantTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - John Lekakis
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dania Mohty
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,Inserm 1094, Limoges School of Medicine, Limoges, France
| | - Petros Nihoyannopoulos
- NHLI - National Heart and Lung Institute, Imperial College London, London, UK.,1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - John Parissis
- Heart Failure Unit, School of Medicine and Department of Cardiology, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, Zurich, University Heart Center, Zurich, Switzerland
| | - Petar Seferovic
- Cardiology Department, Clinical Centre Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dragos Vinereanu
- University of Medicine and Pharmacy 'Carol Davila', and Department of Cardiology, University and Emergency Hospital, Bucharest, Romania
| | - Charalambos Vlachopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Vlastos
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Xaplanteris
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Reuven Zimlichman
- Department of Medicine and Hypertension Institute, Brunner Institute for Cardiovascular Research, Sackler Faculty of Medicine, The E. Wolfson Medical Center, Institute for Quality in Medicine, Israeli Medical Association, Tel Aviv University, Tel Aviv, Israel
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Gabr RE, El-Sharkawy AMM, Schär M, Panjrath GS, Gerstenblith G, Weiss RG, Bottomley PA. Cardiac work is related to creatine kinase energy supply in human heart failure: a cardiovascular magnetic resonance spectroscopy study. J Cardiovasc Magn Reson 2018; 20:81. [PMID: 30526611 PMCID: PMC6287363 DOI: 10.1186/s12968-018-0491-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 09/12/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It has been hypothesized that the supply of chemical energy may be insufficient to fuel normal mechanical pump function in heart failure (HF). The creatine kinase (CK) reaction serves as the heart's primary energy reserve, and the supply of adenosine triphosphate (ATP flux) it provides is reduced in human HF. However, the relationship between the CK energy supply and the mechanical energy expended has never been quantified in the human heart. This study tests whether reduced CK energy supply is associated with reduced mechanical work in HF patients. METHODS Cardiac mechanical work and CK flux in W/kg, and mechanical efficiency were measured noninvasively at rest using cardiac pressure-volume loops, magnetic resonance imaging and phosphorus spectroscopy in 14 healthy subjects and 27 patients with mild-to-moderate HF. RESULTS In HF, the resting CK flux (126 ± 46 vs. 179 ± 50 W/kg, p < 0.002), the average (6.8 ± 3.1 vs. 10.1 ± 1.5 W/kg, p <0.001) and the peak (32 ± 14 vs. 48 ± 8 W/kg, p < 0.001) cardiac mechanical work-rates, as well as the cardiac mechanical efficiency (53% ± 16 vs. 79% ± 3, p < 0.001), were all reduced by a third compared to healthy subjects. In addition, cardiac CK flux correlated with the resting peak and average mechanical power (p < 0.01), and with mechanical efficiency (p = 0.002). CONCLUSION These first noninvasive findings showing that cardiac mechanical work and efficiency in mild-to-moderate human HF decrease proportionately with CK ATP energy supply, are consistent with the energy deprivation hypothesis of HF. CK energy supply exceeds mechanical work at rest but lies within a range that may be limiting with moderate activity, and thus presents a promising target for HF treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00181259 .
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Affiliation(s)
- Refaat E. Gabr
- Division of MR Research, Department of Radiology, The Johns Hopkins University, Park Building, 600 N Wolfe St, Baltimore, MD 21287 USA
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, Texas USA
| | - AbdEl-Monem M. El-Sharkawy
- Division of MR Research, Department of Radiology, The Johns Hopkins University, Park Building, 600 N Wolfe St, Baltimore, MD 21287 USA
- Systems and Biomedical Engineering Department, Faculty of Engineering, Cairo University, Giza, Egypt
| | - Michael Schär
- Division of MR Research, Department of Radiology, The Johns Hopkins University, Park Building, 600 N Wolfe St, Baltimore, MD 21287 USA
| | - Gurusher S. Panjrath
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD USA
- The GW Heart and Vascular Institute, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD USA
| | - Robert G. Weiss
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD USA
| | - Paul A. Bottomley
- Division of MR Research, Department of Radiology, The Johns Hopkins University, Park Building, 600 N Wolfe St, Baltimore, MD 21287 USA
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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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15
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Nayyar S, Suszko A, Porta-Sanchez A, Dalvi R, Chauhan VS. Reduced T wave alternans in heart failure responders to cardiac resynchronization therapy: Evidence of electrical remodeling. PLoS One 2018; 13:e0199637. [PMID: 29953465 PMCID: PMC6023131 DOI: 10.1371/journal.pone.0199637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/11/2018] [Indexed: 01/25/2023] Open
Abstract
Background T-wave alternans (TWA), a marker of electrical instability, can be modulated by cardiac resynchronization therapy (CRT). The relationship between TWA and heart failure response to CRT has not been clearly defined. Methods and results In 40-patients (age 65±11 years, left ventricular ejection-fraction [LVEF] 23±7%), TWA was evaluated prospectively at median of 2 months (baseline) and 8 months (follow-up) post-CRT implant. TWA-magnitude (Valt >0μV, k≥3), its duration (d), and burden (Valt ·d) were quantified in moving 128-beat segments during incremental atrial (AAI, native-TWA) and atrio-biventricular (DDD-CRT) pacing. The immediate and long-term effect of CRT on TWA was examined. Clinical response to CRT was defined as an increase in LVEF of ≥5%. Native-TWA was clinically significant (Valt ≥1.9μV, k≥3) in 68% of subjects at baseline. Compared to native-TWA at baseline, DDD-CRT pacing at baseline and follow-up reduced the number of positive TWA segments, peak-magnitude, longest-duration and peak-burden of TWA (44±5 to 33±5 to 28±4%, p = 0.02 and 0.002; 5.9±0.8 to 4.1±0.7 to 3.8±0.7μV, p = 0.01 and 0.01; 97±9 to 76±8 to 67±8sec, p = 0.004 and <0.001; and 334±65 to 178±58 to 146±54μV.sec, p = 0.01 and 0.004). In addition, the number of positive segments and longest-duration of native-TWA diminished during follow-up (44±5 to 35±6%, p = 0.044; and 97±9 to 81±9sec, p = 0.02). Clinical response to CRT was observed in 71% of patients; the reduction in DDD-CRT paced TWA both at baseline and follow-up was present only in responders (interaction p-values <0.1). Conclusion Long-term CRT reduces the prevalence and magnitude of TWA. This CRT induced beneficial electrical remodeling is a marker of clinical response after CRT.
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Affiliation(s)
- Sachin Nayyar
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Adrian Suszko
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Andreu Porta-Sanchez
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Rupin Dalvi
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
| | - Vijay S. Chauhan
- Peter Munk Cardiac Center, Division of Cardiology, University Health Network, Toronto, ON, Canada
- * E-mail:
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16
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Claridge S, Briceno N, Chen Z, De Silva K, Modi B, Jackson T, Behar JM, Niederer S, Rinaldi CA, Perera D. Changes in contractility determine coronary haemodynamics in dyssynchronous left ventricular heart failure, not vice versa. IJC HEART & VASCULATURE 2018; 19:8-13. [PMID: 29946557 PMCID: PMC6016072 DOI: 10.1016/j.ijcha.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Biventricular pacing has been shown to increase both cardiac contractility and coronary flow acutely but the causal relationship is unclear. We hypothesised that changes in coronary flow are secondary to changes in cardiac contractility. We sought to examine this relationship by modulating coronary flow and cardiac contractility. METHODS Contractility and lusitropy were altered by varying the location of pacing in 8 patients. Coronary autoregulation was transiently disabled with intracoronary adenosine. Simultaneous coronary flow velocity, coronary pressure and left ventricular pressure data were measured in the different pacing settings with and without hyperaemia and wave intensity analysis performed. RESULTS Multisite pacing was effective at altering left ventricular contractility and lusitropy (pos. dp/dtmax -13% to +10% and neg. dp/dtmax -15% to +17% compared to baseline). Intracoronary adenosine decreased microvascular resistance (362.5 mm Hg/s/m to 156.7 mm Hg/s/m, p < 0.001) and increased LAD flow velocity (22 cm/s vs 45 cm/s, p < 0.001) but did not acutely change contractility or lusitropy. The magnitude of the dominant accelerating wave, the Backward Expansion Wave, was proportional to the degree of contractility as well as lusitropy (r = 0.47, p < 0.01 and r = -0.50, p < 0.01). Perfusion efficiency (the proportion of accelerating waves) increased at hyperaemia (76% rest vs 81% hyperaemia, p = 0.04). Perfusion efficiency correlated with contractility and lusitropy at rest (r = 0.43 & -0.50 respectively, p = 0.01) and hyperaemia (r = 0.59 & -0.6, p < 0.01). CONCLUSIONS Acutely increasing coronary flow with adenosine in patients with systolic heart failure does not increase contractility. Changes in coronary flow with biventricular pacing are likely to be a consequence of enhanced cardiac contractility from resynchronization and not vice versa.
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Affiliation(s)
- Simon Claridge
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Natalia Briceno
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Zhong Chen
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Kalpa De Silva
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Bhavik Modi
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Jonathan M. Behar
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Steven Niederer
- Department of Imaging Sciences, King's College, London, United Kingdom
| | | | - Divaka Perera
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
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Nguyên UC, Verzaal NJ, van Nieuwenhoven FA, Vernooy K, Prinzen FW. Pathobiology of cardiac dyssynchrony and resynchronization therapy. Europace 2018; 20:1898-1909. [DOI: 10.1093/europace/euy035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/16/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Nienke J Verzaal
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frans A van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
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Lee AWC, Costa CM, Strocchi M, Rinaldi CA, Niederer SA. Computational Modeling for Cardiac Resynchronization Therapy. J Cardiovasc Transl Res 2018; 11:92-108. [PMID: 29327314 PMCID: PMC5908824 DOI: 10.1007/s12265-017-9779-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/18/2017] [Indexed: 11/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF) patients with an electrical substrate pathology causing ventricular dyssynchrony. However 40-50% of patients do not respond to treatment. Cardiac modeling of the electrophysiology, electromechanics, and hemodynamics of the heart has been used to study mechanisms behind HF pathology and CRT response. Recently, multi-scale dyssynchronous HF models have been used to study optimal device settings and optimal lead locations, investigate the underlying cardiac pathophysiology, as well as investigate emerging technologies proposed to treat cardiac dyssynchrony. However the breadth of patient and experimental data required to create and parameterize these models and the computational resources required currently limits the use of these models to small patient numbers. In the future, once these technical challenges are overcome, biophysically based models of the heart have the potential to become a clinical tool to aid in the diagnosis and treatment of HF.
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Affiliation(s)
- Angela W C Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | | | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Gielgens R, Herold I, van Straten A, van Gelder B, Bracke F, Korsten H, Soliman Hamad M, Bouwman R. The Hemodynamic Effects of Different Pacing Modalities After Cardiopulmonary Bypass in Patients With Reduced Left Ventricular Function. J Cardiothorac Vasc Anesth 2018; 32:259-266. [DOI: 10.1053/j.jvca.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 11/11/2022]
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Ojo A, Tariq S, Harikrishnan P, Iwai S, Jacobson JT. Cardiac Resynchronization Therapy for Heart Failure. Interv Cardiol Clin 2017; 6:417-426. [PMID: 28600094 DOI: 10.1016/j.iccl.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiac resynchronization therapy (CRT) has emerged as a valued nonpharmacologic therapy in patients with heart failure, reduced ejection fraction (EF), and ventricular dyssynchrony manifest as left bundle branch block. The mechanisms of benefit include remodeling of the left ventricle leading to decreased dimensions and increased EF, as well as a decrease in the severity of mitral regurgitation. This article reviews the rationale, effects, and indications for CRT, and discusses the patient characteristics that predict response and considerations for nonresponders.
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Affiliation(s)
- Amole Ojo
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Sohaib Tariq
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Prakash Harikrishnan
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Sei Iwai
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Jason T Jacobson
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
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LEE ANGELAWC, CROZIER ANDREW, HYDE EOINR, LAMATA PABLO, TRUONG MICHAEL, SOHAL MANAV, JACKSON THOMAS, BEHAR JONATHANM, CLARIDGE SIMON, SHETTY ANOOP, SAMMUT EVA, PLANK GERNOT, RINALDI CHRISTOPHERALDO, NIEDERER STEVEN. Biophysical Modeling to Determine the Optimization of Left Ventricular Pacing Site and AV/VV Delays in the Acute and Chronic Phase of Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2017; 28:208-215. [PMID: 27885749 PMCID: PMC5535003 DOI: 10.1111/jce.13134] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiac anatomy and function adapt in response to chronic cardiac resynchronization therapy (CRT). The effects of these changes on the optimal left ventricle (LV) lead location and timing delay settings have yet to be fully explored. OBJECTIVE To predict the effects of chronic CRT on the optimal LV lead location and device timing settings over time. METHODS Biophysical computational cardiac models were generated for 3 patients, immediately post-implant (ACUTE) and after at least 6 months of CRT (CHRONIC). Optimal LV pacing area and device settings were predicted by pacing the ACUTE and CHRONIC models across the LV epicardium (49 sites each) with a range of 9 pacing settings and simulating the acute hemodynamic response (AHR) of the heart. RESULTS There were statistically significant differences between the distribution of the AHR in the ACUTE and CHRONIC models (P < 0.0005 in all cases). The site delivering the maximal AHR shifted location between the ACUTE and CHRONIC models but provided a negligible improvement (<2%). The majority of the acute optimal LV pacing regions (76-100%) and device settings (76-91%) remained optimal chronically. CONCLUSION Optimization of the LV pacing location and device settings were important at the time of implant, with a reduced benefit over time, where the majority of the acute optimal LV pacing region and device settings remained optimal with chronic CRT.
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Affiliation(s)
- ANGELA W. C. LEE
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - ANDREW CROZIER
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - EOIN R. HYDE
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - PABLO LAMATA
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - MICHAEL TRUONG
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - MANAV SOHAL
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - THOMAS JACKSON
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - JONATHAN M. BEHAR
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - SIMON CLARIDGE
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - ANOOP SHETTY
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - EVA SAMMUT
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - GERNOT PLANK
- Institute of BiophysicsMedical University of GrazGrazAustria
| | - CHRISTOPHER ALDO RINALDI
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiovascular DepartmentGuy's and St. Thomas’ NHS Foundation TrustLondonUK
| | - STEVEN NIEDERER
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
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Patterson T, Schreuder J, Burkhoff D, Vanderheyden M, Rajani R, Toth G, Redwood SR, Bartunek J. Percutaneous Ventricular Restoration Using the Parachute Device: The Parachute III Pressure-Volume Loop Sub-study. STRUCTURAL HEART 2017. [DOI: 10.1080/24748706.2017.1329574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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23
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Schreurs R, Wiegerinck RF, Prinzen FW. Exploring the Electrophysiologic and Hemodynamic Effects of Cardiac Resynchronization Therapy: From Bench to Bedside and Vice Versa. Heart Fail Clin 2016; 13:43-52. [PMID: 27886931 DOI: 10.1016/j.hfc.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an important therapy for heart failure patients with prolonged QRS duration. In patients with left bundle branch block the altered left ventricular electrical activation results in dyssynchronous, inefficient contraction of the left ventricle. CRT aims to reverse these changes and to improve cardiac function. This article explores the electrophysiologic and hemodynamic changes that occur during CRT in patient and animal studies. It also addresses how novel techniques, such as multipoint and endocardial pacing, can further improve the electromechanical response.
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Affiliation(s)
- Rick Schreurs
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rob F Wiegerinck
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
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Padeletti L, Pieragnoli P, Ricciardi G, Innocenti L, Checchi L, Padeletti M, Michelucci A, Picariello F, Valsecchi S. Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003793. [DOI: 10.1161/circep.115.003793] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/07/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Luigi Padeletti
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
| | - Paolo Pieragnoli
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
| | - Giuseppe Ricciardi
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
| | - Lisa Innocenti
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
| | - Luca Checchi
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
| | - Margherita Padeletti
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
| | - Antonio Michelucci
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
| | - Francesco Picariello
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
| | - Sergio Valsecchi
- From the Heart and Vessels Department, University of Florence, Florence (L.P., P.P., G.R., L.I., L.C., A.M.); Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (Milan) (L.P.); Department of Cardiovascular Diseases, University of Siena, Siena (M.P.); and CRM Department, Boston Scientific Italia, Milan, Italy (F.P., S.V.)
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25
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DeVecchi F, Facchini E, Degiovanni A, Sartori C, Cavallino C, Santagostino M, Di Ruocco V, Magnani A, Occhetta E, Marino PN. Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization. IJC HEART & VASCULATURE 2016; 11:66-73. [PMID: 28616528 PMCID: PMC5441335 DOI: 10.1016/j.ijcha.2016.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/16/2016] [Accepted: 03/19/2016] [Indexed: 11/18/2022]
Abstract
Background It has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists about the capacity of this approach to predict a long-term clinical response. This study's purpose was to assess whether long-term CRT clinical effects can be predicted according to acute inotropic response induced by biventricular stimulation (CRT on), as compared with AAI–VVI right stimulation pacing mode (CRT off), quantified at the time of implantation. Methods In 98 patients (ejection fraction 29 ± 10%), acute changes in left ventricular (LV) elastance (Ees), arterial elastance (Ea), and Ees/Ea, as assessed from slope changes of the force–frequency relation obtained when the heart rate increased, and also assessed while measuring triplane LV volumes and continuous noninvasive blood pressure, were related to death or rehospitalization during a 3-year follow-up. Other covariances tested were age, gender, disease etiology, QRS duration, amount of mitral regurgitation, LV diastolic volume, ejection fraction, and the degree of asynchrony and longitudinal strain at baseline. Results There was a marked increment in the Ees slope with CRT (interaction P = 0.004), no Ea change, and modest Ees/Ea increase (interaction P < 0.05). In Cox analysis, however, neither slope changes nor baseline values of Ees, Ea, and Ees/Ea were associated with long-term follow-up. Only ventricular diastolic volume (direct relation P = 0.002) and QRS duration (inverse relation P = 0.009) predicted death/rehospitalization. Conclusions Acute contractile recovery in CRT patients is not associated with 3 years prognosis. Instead, death or rehospitalization can be predicted from QRS duration and LV diastolic volume at baseline.
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Key Words
- CRT, biventricular stimulation
- Congestive heart failure
- DYS, dyssynchrony
- Dyssynchrony
- EDV, end-diastolic volume
- EF, ejection fraction
- Ea, arterial elastance
- Ees, ventricular elastance
- FFR, force–frequency relation
- Force–frequency relation
- HR, hazard ratio
- LV, left ventricle
- MR, mitral regurgitation
- Resynchronization
- Speckle-tracking echocardiography
- TUS, temporal uniformity of strain
- r2, adjusted r squared
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26
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Claridge S, Chen Z, Jackson T, De Silva K, Behar J, Sohal M, Webb J, Hyde E, Lumley M, Asrress K, Williams R, Bostock J, Ali M, Gill J, O'Neill M, Razavi R, Niederer S, Perera D, Rinaldi CA. Effects of Epicardial and Endocardial Cardiac Resynchronization Therapy on Coronary Flow: Insights From Wave Intensity Analysis. J Am Heart Assoc 2015; 4:JAHA.115.002626. [PMID: 26679935 PMCID: PMC4845290 DOI: 10.1161/jaha.115.002626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background The increase in global coronary flow seen with conventional biventricular pacing is mediated by an increase in the dominant backward expansion wave (BEW). Little is known about the determinants of flow in the left‐sided epicardial coronary arteries beyond this or the effect of endocardial pacing stimulation on coronary physiology. Methods and Results Eleven patients with a chronically implanted biventricular pacemaker underwent an acute hemodynamic and electrophysiological study. Five of 11 patients also took part in a left ventricular endocardial pacing protocol at the same time. Conventional biventricular pacing, delivered epicardially from the coronary sinus, resulted in a 9% increase in flow (average peak velocity) in the left anterior descending artery (LAD), mediated by a 13% increase in the area under the BEW (P=0.004). Endocardial pacing resulted in a 27% increase in LAD flow, mediated by a 112% increase in the area under the forward compression wave (FCW) and a 43% increase in the area under the BEW (P=0.048 and P=0.036, respectively). There were no significant changes in circumflex parameters. Conventional biventricular pacing resulted in homogenization of timing of coronary flow compared with baseline (mean difference in time to peak in the LAD versus circumflex artery: FCW 39 ms [baseline] versus 3 ms [conventional biventricular pacing], P=0.008; BEW 47 ms [baseline] versus 8 ms [conventional biventricular pacing], P=0.004). Conclusions Epicardial and endocardial pacing result in increased coronary flow in the left anterior descending artery and homogenization of the timing of waves that determine flow in the LAD and the circumflex artery. The increase in both the FCW and the BEW with endocardial pacing may be the result of a more physiological activation pattern than that of epicardial pacing, which resulted in an increase of only the BEW.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Motin Ali
- Guy's and St Thomas’ Hospital TrustLondonUK
| | - Jaswinder Gill
- Guy's and St Thomas’ Hospital Trust and King's CollegeLondonUK
| | - Mark O'Neill
- Guy's and St Thomas’ Hospital Trust and King's CollegeLondonUK
| | - Reza Razavi
- Guy's and St Thomas’ Hospital Trust and King's CollegeLondonUK
| | | | - Divaka Perera
- Guy's and St Thomas’ Hospital Trust and King's CollegeLondonUK
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27
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Schreurs R, Wiegerinck RF, Prinzen FW. Exploring the Electrophysiologic and Hemodynamic Effects of Cardiac Resynchronization Therapy: From Bench to Bedside and Vice Versa. Card Electrophysiol Clin 2015; 7:599-608. [PMID: 26596805 DOI: 10.1016/j.ccep.2015.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an important therapy for heart failure patients with prolonged QRS duration. In patients with left bundle branch block the altered left ventricular electrical activation results in dyssynchronous, inefficient contraction of the left ventricle. CRT aims to reverse these changes and to improve cardiac function. This article explores the electrophysiologic and hemodynamic changes that occur during CRT in patient and animal studies. It also addresses how novel techniques, such as multipoint and endocardial pacing, can further improve the electromechanical response.
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Affiliation(s)
- Rick Schreurs
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rob F Wiegerinck
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
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28
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Cherpanath TGV, Smeding L, Hirsch A, Lagrand WK, Schultz MJ, Groeneveld ABJ. Low tidal volume ventilation ameliorates left ventricular dysfunction in mechanically ventilated rats following LPS-induced lung injury. BMC Anesthesiol 2015; 15:140. [PMID: 26446079 PMCID: PMC4597388 DOI: 10.1186/s12871-015-0123-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 10/03/2015] [Indexed: 01/06/2023] Open
Abstract
Background High tidal volume ventilation has shown to cause ventilator-induced lung injury (VILI), possibly contributing to concomitant extrapulmonary organ dysfunction. The present study examined whether left ventricular (LV) function is dependent on tidal volume size and whether this effect is augmented during lipopolysaccharide(LPS)-induced lung injury. Methods Twenty male Wistar rats were sedated, paralyzed and then randomized in four groups receiving mechanical ventilation with tidal volumes of 6 ml/kg or 19 ml/kg with or without intrapulmonary administration of LPS. A conductance catheter was placed in the left ventricle to generate pressure-volume loops, which were also obtained within a few seconds of vena cava occlusion to obtain relatively load-independent LV systolic and diastolic function parameters. The end-systolic elastance / effective arterial elastance (Ees/Ea) ratio was used as the primary parameter of LV systolic function with the end-diastolic elastance (Eed) as primary LV diastolic function. Results Ees/Ea decreased over time in rats receiving LPS (p = 0.045) and high tidal volume ventilation (p = 0.007), with a lower Ees/Ea in the rats with high tidal volume ventilation plus LPS compared to the other groups (p < 0.001). Eed increased over time in all groups except for the rats receiving low tidal volume ventilation without LPS (p = 0.223). A significant interaction (p < 0.001) was found between tidal ventilation and LPS for Ees/Ea and Eed, and all rats receiving high tidal volume ventilation plus LPS died before the end of the experiment. Conclusions Low tidal volume ventilation ameliorated LV systolic and diastolic dysfunction while preventing death following LPS-induced lung injury in mechanically ventilated rats. Our data advocates the use of low tidal volumes, not only to avoid VILI, but to avert ventilator-induced myocardial dysfunction as well.
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Affiliation(s)
- Thomas G V Cherpanath
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Lonneke Smeding
- Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Alexander Hirsch
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Wim K Lagrand
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Marcus J Schultz
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - A B Johan Groeneveld
- Department of Intensive Care Medicine, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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29
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Höke U, Khidir MJH, van der Velde ET, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Cardiac Resynchronization Therapy in CKD Stage 4 Patients. Clin J Am Soc Nephrol 2015; 10:1740-8. [PMID: 26408549 DOI: 10.2215/cjn.00620115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 07/08/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cardiac resynchronization therapy (CRT) is a well established heart failure treatment that has shown to improve renal function. However, landmark CRT trials excluded patients with severe renal dysfunction. Therefore, this study evaluated the effect of CRT on renal function and long-term prognosis in patients with stage 4 CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study evaluated 73 consecutive CRT patients (71±10 years) with stage 4 CKD who underwent echocardiographic and renal function evaluation at baseline and 6-month follow-up between 2000 and 2012. As a control group, 18 patients with stage 4 CKD who received an implantable cardioverter defibrillator (ICD) were selected. CRT recipients with ≥15% reduction in left ventricular end-systolic volume at 6-month follow-up were classified as CRT responders. During long-term follow-up (median, 33 months), appropriate defibrillator therapy, heart failure hospitalizations, and all-cause mortality (combined end point) were recorded. RESULTS At 6-month follow-up, a significant reduction in left ventricular end-systolic volume was observed in CRT patients compared with patients with ICD (from 159±78 to 145±78 ml in CRT patients and from 126±54 to 119±49 ml in ICD patients; P=0.05), and CRT response was observed in 22 patients (30%). Compared with ICD patients, eGFR improved among CRT patients (from 25±4 to 30±9 ml/min per 1.73 m(2); interaction time and group, P=0.04) and was more pronounced among CRT responders (25±3 to 34±9 ml/min per 1.73 m(2); P<0.001). The combined end point was observed in 17 ICD and 62 CRT patients. CRT patients showed superior survival compared with ICD patients (log-rank P=0.03). More importantly, CRT response was independently associated with improved survival free from the combined end point (hazard ratio, 0.51; 95% confidence interval, 0.27 to 0.98; P=0.04) after adjustment for clinical and echocardiographic parameters. CONCLUSIONS Response to CRT occurs in approximately 30% of patients with stage 4 CKD, which is less than in the average CRT population. CRT was associated with better clinical outcome, and particularly, CRT response was associated with improvement in eGFR and better long-term prognosis.
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Affiliation(s)
- Ulas Höke
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
| | - Mand J H Khidir
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Enno T van der Velde
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; and
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30
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Kim CH, Olson LJ, Shen WK, Cha YM, Johnson BD. Ventilatory gas exchange and early response to cardiac resynchronization therapy. J Heart Lung Transplant 2015; 34:1430-5. [PMID: 26163155 DOI: 10.1016/j.healun.2015.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/17/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an accepted intervention for chronic heart failure (HF), although approximately 30% of patients are non-responders. The purpose of this study was to determine whether exercise respiratory gas exchange obtained before CRT implantation predicts early response to CRT. METHODS Before CRT implantation, patients were assigned to either a mild-moderate group (Mod G, n = 33, age 67 ± 10 years) or a moderate-severe group (Sev G, n = 31, age 67 ± 10 years), based on abnormalities in exercise gas exchange. Severity of impaired gas exchange was based on a score from the measures of VE/VCO(2) slope, resting PETCO(2) and change of PETCO(2) from resting to peak. All measurements were performed before and 3 to 4 months after CRT implantation. RESULTS Although Mod G did not have improved gas exchange (p > 0.05), Sev G improved significantly (p < 0.05) post-CRT. In addition, Mod G did not show improved right ventricular systolic pressure (RSVP; pre vs post: 37 ± 14 vs 36 ± 11 mm Hg, p > 0.05), yet Sev G showed significantly improved RVSP, by 23% (50 ± 14 vs 42 ± 12 mm Hg, p < 0.05). Both groups had improved left ventricular ejection fraction (p < 0.05), New York Heart Association class (p < 0.05) and quality of life (p < 0.05), but no significant differences were observed between groups (p > 0.05). No significant changes were observed in brain natriuretic peptide in either group post-CRT. CONCLUSION Based on pre-CRT implantation ventilatory gas exchange, subjects with the most impaired values appeared to have more improvement post-CRT, possibly associated with a decrease in RVSP.
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Affiliation(s)
- Chul-Ho Kim
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | - Lyle J Olson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Win K Shen
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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31
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PIERAGNOLI PAOLO, PEREGO GIOVANNIBATTISTA, RICCIARDI GIUSEPPE, SACCHI STEFANIA, PADELETTI MARGHERITA, MICHELUCCI ANTONIO, VALSECCHI SERGIO, PADELETTI LUIGI. Cardiac Resynchronization Therapy Acutely Improves Ventricular-Arterial Coupling by Reducing the Arterial Load: Assessment by Pressure-Volume Loops. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:431-7. [DOI: 10.1111/pace.12585] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/21/2014] [Accepted: 12/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | - LUIGI PADELETTI
- University of Florence; Florence Italy
- Gavazzeni Hospital; Bergamo Italy
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32
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OSCA JOAQUÍN, ALONSO PAU, CANO ÓSCAR, SÁNCHEZ JUANMIGUEL, TEJADA DAVID, ANDRÉS ANA, SANCHO TELLO MARÍAJOSÉ, OLAGÜE JOSÉ. The Use of Quadripolar Left Ventricular Leads Improves the Hemodynamic Response to Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:326-33. [DOI: 10.1111/pace.12545] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/09/2014] [Accepted: 10/19/2014] [Indexed: 11/29/2022]
Affiliation(s)
- JOAQUÍN OSCA
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - PAU ALONSO
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - ÓSCAR CANO
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - JUAN MIGUEL SÁNCHEZ
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - DAVID TEJADA
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - ANA ANDRÉS
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - MARÍA JOSÉ SANCHO TELLO
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - JOSÉ OLAGÜE
- Electrophysiology Section; Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
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33
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Warriner DR, Brown AG, Varma S, Sheridan PJ, Lawford P, Hose DR, Al-Mohammad A, Shi Y. Closing the loop: modelling of heart failure progression from health to end-stage using a meta-analysis of left ventricular pressure-volume loops. PLoS One 2014; 9:e114153. [PMID: 25479594 PMCID: PMC4257583 DOI: 10.1371/journal.pone.0114153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction The American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for the classification of heart failure (HF) are descriptive but lack precise and objective measures which would assist in categorising such patients. Our aim was two fold, firstly to demonstrate quantitatively the progression of HF through each stage using a meta-analysis of existing left ventricular (LV) pressure-volume (PV) loop data and secondly use the LV PV loop data to create stage specific HF models. Methods and Results A literature search yielded 31 papers with PV data, representing over 200 patients in different stages of HF. The raw pressure and volume data were extracted from the papers using a digitising software package and the means were calculated. The data demonstrated that, as HF progressed, stroke volume (SV), ejection fraction (EF%) decreased while LV volumes increased. A 2-element lumped parameter model was employed to model the mean loops and the error was calculated between the loops, demonstrating close fit between the loops. The only parameter that was consistently and statistically different across all the stages was the elastance (Emax). Conclusions For the first time, the authors have created a visual and quantitative representation of the AHA/ACC stages of LVSD-HF, from normal to end-stage. The study demonstrates that robust, load-independent and reproducible parameters, such as elastance, can be used to categorise and model HF, complementing the existing classification. The modelled PV loops establish previously unknown physiological parameters for each AHA/ACC stage of LVSD-HF, such as LV elastance and highlight that it this parameter alone, in lumped parameter models, that determines the severity of HF. Such information will enable cardiovascular modellers with an interest in HF, to create more accurate models of the heart as it fails.
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Affiliation(s)
- David R. Warriner
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, United Kingdom
- * E-mail:
| | - Alistair G. Brown
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Susheel Varma
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Paul J. Sheridan
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, United Kingdom
| | - Patricia Lawford
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - David R. Hose
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Abdallah Al-Mohammad
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, United Kingdom
| | - Yubing Shi
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
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34
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Ståhlberg M, Sander M, Mortensen L, Linde C, Braunschweig F. Increase in paced heart rate reduces muscle sympathetic nerve activity in heart failure patients treated with cardiac resynchronization therapy. Europace 2014; 17:439-46. [PMID: 25355780 DOI: 10.1093/europace/euu289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS To test the hypothesis that acute increased biventricularly (BiV) paced heart rate (pHR) results in decreased muscle sympathetic nerve activity (MSNA), and that dyssynchronous pacing (AAI) attenuates this effect, in heart failure patients receiving cardiac resynchronization therapy (CRT). METHODS AND RESULTS Fourteen CRT patients (NYHA II-III, 12 males, mean EF 28 ± 14%) were recruited. Three different pHRs (50-90 b.p.m.) were randomly programmed in BiV- and AAI-pacing modes. Muscle sympathetic nerve activity (total sympathetic nerve activity/min (units) and number of bursts/100 RR) were recorded from the peroneal nerve using a microelectrode. In addition, cardiac output (CO) and mean blood pressure (mBP) were measured. With BiV pacing, the total MSNA/min was lower at 70 b.p.m. (-7 ± 21%, P = 0.18) and 90 b.p.m. (-29 ± 18%, P = 0.01) compared with at 50 b.p.m. (280 ± 180 U). Similarly, bursts/100RR decreased with increased BiV pHR. Cardiac output (3.7 L/min at 50 b.p.m., +12 ± 12% at 70 b.p.m., and +18 ± 19% at 90 b.p.m.) and mBP (78 ± 11 mmHg at 50 b.p.m., +6 ± 6% at 70 b.p.m. and +11 ± 8% at 90 b.p.m.) increased significantly at elevated pHRs in BiV-pacing mode. The effect on MSNA, CO, and mBP was less pronounced in AAImode but we found no significant differences between the pacing modes. CONCLUSION Increased pHR acutely reduces MSNA and improves haemodynamics in HF patients treated with CRT with no evident differences between BiV- and AAI-pacing modes. Further studies are warranted to guide the programming of basic pHR in CRT patients.
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Affiliation(s)
- Marcus Ståhlberg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Mikael Sander
- Department of Cardiology, Copenhagen University Hospital at Hvidovre, Copenhagen, Denmark
| | - Lars Mortensen
- Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Cecilia Linde
- Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
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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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Kato H, Shimano M, Sumi T, Murakami H, Kada K, Inden Y, Tsuboi N, Murohara T. Acute improvement of left ventricular relaxation as a predictor of volume reduction after cardiac resynchronization therapy: a pilot study assessing the value of left ventricular hemodynamic parameter. Pacing Clin Electrophysiol 2014; 37:1544-52. [PMID: 25113752 DOI: 10.1111/pace.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 05/31/2014] [Accepted: 06/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves cardiac function, but CRT recipients with advanced heart failure (HF) do not always respond well. Because the best parameters for the prediction of CRT response are not established, we investigated whether improvement of invasive left ventricular (LV) hemodynamic diastolic parameters could identify CRT responders. METHODS A total of 34 consecutive patients (age, 69 ± 9 years; 70% men) who received CRT devices for HF were assessed as to whether acute invasive hemodynamic parameters with and without CRT function could predict LV volume responders. RESULTS These patients demonstrated an improvement in LV dP/dtmax (11.1 ± 11.7%), LV dP/dtmin (4.6 ± 12.1%), and tau (3.7 ± 11.6%) by biventricular pacing. Nineteen patients (55%) were classified as CRT responders, which was defined by a >15% decrease in LV end-systolic volume (ESV) at the 6-month follow-up evaluation. The area under the receiver operator characteristic curve to detect CRT volume response was 0.93 for the shortening of tau, which was superior to any other hemodynamic parameter. The multivariate analysis revealed that this improvement in tau was the strongest predictive factor for identifying CRT volume responders. Of note, the magnitude of tau shortening during biventricular pacing was significantly correlated with the reduction in LVESV at the 6-month follow-up evaluation. CONCLUSIONS The extent of acute improvement in LV isovolumic relaxation time, as assessed by tau, was associated with favorable response to CRT. The assessment of invasive diastolic function could provide valuable information about CRT volume response.
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Affiliation(s)
- Hiroyuki Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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Derval N, Bordachar P, Lim HS, Sacher F, Ploux S, Laborderie J, Steendijk P, Deplagne A, Ritter P, Garrigue S, Denis A, Hocini M, Haissaguerre M, Clementy J, Jaïs P. Impact of pacing site on QRS duration and its relationship to hemodynamic response in cardiac resynchronization therapy for congestive heart failure. J Cardiovasc Electrophysiol 2014; 25:1012-1020. [PMID: 24891271 DOI: 10.1111/jce.12464] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Recent studies have demonstrated that left ventricular (LV) pacing site is a critical parameter in optimizing cardiac resynchronization therapy (CRT). The present study evaluates the effect of pacing from different LV locations on QRS duration (QRSd) and their relationship to acute hemodynamic response in congestive heart failure patients. METHODS AND RESULTS Thirty-five patients with nonischemic dilated cardiomyopathy and left bundle branch block referred for CRT device implantation were studied. Eleven predetermined LV pacing sites were systematically assessed in random order: epicardial: coronary sinus (CS); endocardial: basal and mid-cavity (septal, anterior, lateral, and inferior), apex, and the endocardial site facing the CS pacing site. For each patient QRSd and +dP/dtmax during baseline (AAI) and DDD LV pacing at 2 atrioventricular delays were compared. Response to CRT was significantly better in patients with wider baseline QRSd (≥150 milliseconds). Hemodynamic response was inversely correlated to increase of QRSd during LV pacing (short atrioventricular [AV] delay: r = 0.44, P < 0.001; long AV delay: r = 0.59, P < 0.001). Compared to baseline, LV pacing at the site of shortest QRSd significantly improved +dP/dtmax (+18 ± 25%, P < 0.001) but was not superior to other conventional strategy (lateral wall, CS pacing, and echo-guided) and was inferior to a hemodynamically guided strategy. CONCLUSIONS In our study, we have demonstrated that changes of QRSd during LV pacing correlated with acute hemodynamic response and that LV pacing location was a primary determinant of paced QRSd. Although QRSd did not predict the maximum hemodynamic response, our results confirm the link between electrical activation and hemodynamic response of the LV during CRT.
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Affiliation(s)
- Nicolas Derval
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Pierre Bordachar
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Han S Lim
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Frederic Sacher
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Sylvain Ploux
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | | | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoine Deplagne
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Philippe Ritter
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | | | - Arnaud Denis
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Mélèze Hocini
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | | | - Jacques Clementy
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
| | - Pierre Jaïs
- Hopital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France
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Systolic heart failure and cardiac resynchronization therapy: a focus on diastole. Int J Cardiovasc Imaging 2014; 30:897-905. [PMID: 24706254 PMCID: PMC4008775 DOI: 10.1007/s10554-014-0412-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/25/2014] [Indexed: 11/03/2022]
Abstract
Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aim of the study was to assess if and how CRT affects DF in systolic heart failure patients. We also investigated potential relations between CRT-induced left ventricular changes and the composite clinical endpoint of progressive heart failure and cardiac death over 3 years follow-up. 119 CRT patients underwent clinical evaluation and echocardiography before CRT and 4 months later. DF was quantified by transmitral velocities [E/A waves, deceleration time (DT), E/DT], early diastolic mitral annulus velocity (E'), E/E' ratio and 2-D speckle tracking strain rate during isovolumetric relaxation (IVR, SRivr). End-diastolic pressure-volume relationship (EDPVR) was also assessed noninvasively using a single-beat method. Overall stiffness was quantified by ventricular stiffness (Klv) normalized to end-diastolic volume (EDV). New York Heart Association class improved at 4 months (from 2.7 ± 0.7 to 1.9 ± 0.6, p < 0.001) as did ventricular filling (E/DT from 0.48 ± 0.29 to 0.39 ± 0.31 cm/s(2), p = 0.01). In contrast, relaxation (E', SRivr) and filling pressures (E/E', E/SRivr) did not change. Slope of EDPVR did not change with CRT. Such finding, together with an unmodified Klv/EDV and a 7 ± 18 % reduction in EDV (p = 0.001), suggested reverse remodelling towards a smaller equilibrium volume. Finally, end-systolic LV volume decreased from 147 ± 59 to 125 ± 52 ml and ejection fraction increased from 0.26 ± 0.07 to 0.32 ± 0.09 (both p < 0.001). Using a Cox regression model we found that only changes (Δ) in diastolic, but not systolic indexes, correlated with the composite clinical endpoint, with increments in ΔEDV20 and ΔE/DT, single or combined, greatly increasing risk of heart failure and/or cardiac death (p = 0.003). Ventricular reverse remodelling, together with improvement in ventricular filling, rather than improvements of systolic function, predict clinical prognosis long-term post-CRT.
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Park SM, Ahn CM, Hong SJ, Kim YH, Park JH, Shim WJ, Lim DS. Acute changes of left ventricular hemodynamics and function during percutaneous coronary intervention in patients with unprotected left main coronary artery disease. Heart Vessels 2014; 30:432-40. [DOI: 10.1007/s00380-014-0495-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/28/2014] [Indexed: 11/30/2022]
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Haemodynamics and left ventricular function in heart failure patients: Comparison of awake versus intra-operative conditions. Eur J Heart Fail 2014; 10:467-74. [DOI: 10.1016/j.ejheart.2008.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 02/27/2008] [Accepted: 03/27/2008] [Indexed: 11/18/2022] Open
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Xi J, Shi W, Rueckert D, Razavi R, Smith NP, Lamata P. Understanding the need of ventricular pressure for the estimation of diastolic biomarkers. Biomech Model Mechanobiol 2013; 13:747-57. [PMID: 24092256 PMCID: PMC4082656 DOI: 10.1007/s10237-013-0531-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/19/2013] [Indexed: 01/08/2023]
Abstract
The diastolic function (i.e., blood filling) of the left ventricle (LV) is determined by its capacity for relaxation, or the decay in residual active tension (AT) generated during systole, and its constitutive material properties, or myocardial stiffness. The clinical determination of these two factors (diastolic residual AT and stiffness) is thus essential for assessing LV diastolic function. To quantify these two factors, in our previous work, a novel model-based parameter estimation approach was proposed and successfully applied to multiple cases using clinically acquired motion and invasively measured ventricular pressure data. However, the need to invasively acquire LV pressure limits the wide application of this approach. In this study, we address this issue by analyzing the feasibility of using two kinds of non-invasively available pressure measurements for the purpose of inverse mechanical parameter estimation. The prescription of pressure based on a generic pressure-volume (P-V) relationship reported in literature is first evaluated in a set of 18 clinical cases (10 healthy and 8 diseased), finding reasonable results for stiffness but not for residual active tension. We then investigate the use of non-invasive pressure measures, now available through imaging techniques and limited by unknown or biased offset values. Specifically, three sets of physiologically realistic synthetic data with three levels of diastolic residual active tension (i.e., impaired relaxation capability) are designed to quantify the percentage error in the parameter estimation against the possible pressure offsets within the physiological limits. Maximum errors are quantified as 11 % for the magnitude of stiffness and 22 % for AT, with averaged 0.17 kPa error in pressure measurement offset using the state-of-the-art non-invasive pressure estimation method. The main cause for these errors is the limited temporal resolution of clinical imaging data currently available. These results demonstrate the potential feasibility of the estimation diastolic biomarkers with non-invasive assessment of pressure through medical imaging data.
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Affiliation(s)
- Jiahe Xi
- Department of Computer Science, Oxford University, Oxford, UK
| | - Wenzhe Shi
- Department of Computing, Imperial College London, London, UK
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK
| | - Reza Razavi
- Department of Biomedical Engineering, St Thomas Hospital, King’s College London, London, UK
| | - Nicolas P. Smith
- Department of Biomedical Engineering, St Thomas Hospital, King’s College London, London, UK
| | - Pablo Lamata
- Department of Computer Science, Oxford University, Oxford, UK
- Department of Biomedical Engineering, St Thomas Hospital, King’s College London, London, UK
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Strik M, van Middendorp LB, Houthuizen P, Ploux S, van Hunnik A, Kuiper M, Auricchio A, Prinzen FW. Interplay of electrical wavefronts as determinant of the response to cardiac resynchronization therapy in dyssynchronous canine hearts. Circ Arrhythm Electrophysiol 2013; 6:924-31. [PMID: 24047705 DOI: 10.1161/circep.113.000753] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relative contribution of electromechanical synchronization and ventricular filling to the optimal hemodynamic effect in cardiac resynchronization therapy (CRT) during adjustment of stimulation-timings is incompletely understood. We investigated whether optimal hemodynamic effect in CRT requires collision of pacing-induced and intrinsic activation waves and optimal filling of the left ventricle (LV). METHODS AND RESULTS CRT was performed in dogs with chronic left bundle-branch block (n=8) or atrioventricular (AV) block (n=6) through atrial (A), right ventricular (RV) apex, and LV-basolateral pacing. A 100 randomized combinations of A-LV/A-RV intervals were tested. Total activation time (TAT) was calculated from >100 contact mapping electrodes. Mechanical interventricular dyssynchrony was determined as the time delay between upslopes of LV and RV pressure curves. Settings providing an increase in LVdP/dtmax (maximal rate of rise of left ventricular pressure) of ≥90% of the maximum LVdP/dtmax value were defined as optimal (CRTopt). Filling was assessed by changes in LV end-diastolic volume (EDV; conductance catheter technique). In all hearts, CRTopt was observed during multiple settings, providing an average LVdP/dtmax increase of ≈15%. In AV-block hearts, CRTopt exclusively depended on interventricular-interval and not on AV-interval. In left bundle-branch block hearts, CRTopt occurred at A-LV intervals that allowed fusion of LV-pacing-derived activation with right bundle-derived activation. In all animals, CRTopt occurred at settings resulting in the largest decrease in TAT and mechanical interventricular dyssynchrony, whereas LV EDV hardly changed. CONCLUSIONS In left bundle-branch block and AV-block hearts, optimal hemodynamic effect of CRT depends on optimal interplay between pacing-induced and intrinsic activation waves and the corresponding mechanical resynchronization rather than filling.
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Affiliation(s)
- Marc Strik
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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Geens JH, Jacobs S, Claus P, Trenson S, Leunens V, Vantichelen I, Rega FR, Verbeken EK, Burkhoff D, Meyns B. Partial mechanical circulatory support in an ovine model of post-infarction remodeling. J Heart Lung Transplant 2013; 32:815-22. [DOI: 10.1016/j.healun.2013.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 05/01/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022] Open
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Remmelink M, Sjauw KD, Yong ZY, Haeck JDE, Vis MM, Koch KT, Tijssen JGP, de Winter RJ, Henriques JPS, Piek JJ, Baan J. Coronary microcirculatory dysfunction is associated with left ventricular dysfunction during follow-up after STEMI. Neth Heart J 2013; 21:238-44. [PMID: 23423600 PMCID: PMC3636343 DOI: 10.1007/s12471-013-0382-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronary microvascular resistance is increased after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), which may be related in part to changed left ventricular (LV) dynamics. Therefore we studied the coronary microcirculation in relation to systolic and diastolic LV function after STEMI. METHODS The study cohort consisted of 12 consecutive patients, all treated with primary PCI for a first anterior wall STEMI. At 4 months, we assessed pressure-volume loops. Subsequently, we measured intracoronary pressure and flow velocity and calculated coronary microvascular resistance. Infarct size and LV mass were assessed using magnetic resonance imaging. RESULTS Patients with an impaired systolic LV function due to a larger myocardial infarction showed a higher baseline average peak flow velocity (APV) than the other patients (26 ± 7 versus 17 ± 5 cm/s, p = 0.003, respectively), and showed an impaired variable microvascular resistance index (2.1 ± 1.0 versus 4.1 ± 1.3 mmHg cm(-1)∙s(-1), p = 0.003, respectively). Impaired diastolic relaxation time was inversely correlated with hyperaemic APV (r = -0.56, p = 0.003) and positively correlated with hyperaemic microvascular resistance (r = 0.48, p = 0.01). LV dilatation was associated with a reduced variable microvascular resistance index (r = 0.78, p = 0.006). CONCLUSION A larger anterior myocardial infarction results in impaired LV performance associated with reduced coronary microvascular resistance variability, in particular due to higher coronary blood flow at baseline in these compromised left ventricles.
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Affiliation(s)
- M Remmelink
- Department of Cardiology, Academic Medical Centre-University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands,
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Vančura V, Wichterle D, Melenovský V, Kautzner J. Assessment of optimal right ventricular pacing site using invasive measurement of left ventricular systolic and diastolic function. ACTA ACUST UNITED AC 2013; 15:1482-90. [DOI: 10.1093/europace/eut068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van der Wall EE. Women and men with stable coronary artery disease: different risk factors but similar outcomes! Neth Heart J 2013; 21:111-2. [PMID: 23344896 DOI: 10.1007/s12471-013-0375-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- E E van der Wall
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Netherlands Heart Institute (NHI), P.O. Box 19258, 3501 DG, Utrecht, the Netherlands,
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PADELETTI LUIGI, PIERAGNOLI PAOLO, RICCIARDI GIUSEPPE, PERROTTA LAURA, PERINI ALESSANDROP, GRIFONI GINO, RICCERI ILARIA, PADELETTI MARGHERITA, LIONETTI VINCENZO, VALSECCHI SERGIO. Larger Interventricular Conduction Time Enhances Mechanical Response to Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:416-23. [DOI: 10.1111/pace.12068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/21/2012] [Accepted: 11/13/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - PAOLO PIERAGNOLI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - GIUSEPPE RICCIARDI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - LAURA PERROTTA
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - ALESSANDRO P. PERINI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - GINO GRIFONI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
| | - ILARIA RICCERI
- Institute of Internal Medicine and Cardiology, University of Florence; Florence; Italy
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Ståhlberg M, Hilpisch K, Reiters P, Linde C, Braunschweig F. Haemodynamic effects of different basic heart rates in ambulatory heart failure patients treated with cardiac resynchronization therapy. Europace 2013; 15:1182-90. [PMID: 23277532 DOI: 10.1093/europace/eus423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The impact of different basic paced heart rates (pHRs) in patients receiving cardiac resynchronization therapy (CRT) remains largely unknown. The aim of the present study was to investigate the haemodynamic effects of different pHRs (60 or 80 b.p.m.), using an implanted haemodynamic monitor (IHM), during a 2-week period in ambulatory CRT patients. METHODS AND RESULTS Ten CRT patients received an IHM (Chronicle(®), Medtronic Inc.) to continuously record right ventricular systolic (RVSP) and diastolic (RVDP) pressure, as well as estimated pulmonary artery diastolic pressure (ePAD) during a 2-week period at two basic pHR programming (60 and 80 b.p.m.). Cardiac output (CO) was calculated using a validated IHM algorithm. At the end of each period, 6 min walk test (6MWT), quality of life (QoL), and plasma levels of brain natriuretic peptide (BNP) were also assessed. Pacing at 80 b.p.m. significantly reduced the 2-week average of ePAD compared with 60 b.p.m. (23.4 ± 6.2 vs. 25.1 ± 6.5 mmHg, P = 0.03), whereas CO was increased (4.5 ± 1.3 vs. 4.2 ± 1.4 L/min; P = 0.01). Similarly ePAD, RVSP, and RVDP were significantly lower with a pHR of 80 b.p.m. (P < 0.05). The 6MWT, QoL score, and BNP were not affected by the pHR. CONCLUSION In CRT patients, a basic pHR of 80 b.p.m. compared with 60 b.p.m. reduces filling pressures and increases CO during a 2-week period of ambulatory living. This suggests that increasing the basic pHR may be considered to achieve short-term haemodynamic improvement. The long-term effects of differential pHR programming remain to be established.
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Affiliation(s)
- Marcus Ståhlberg
- Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, S-17176 Stockholm, Sweden.
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Abstract
Heart failure (HF) is a global phenomenon, and the overall incidence and prevalence of the condition are steadily increasing. Medical therapies have proven efficacious, but only a small number of pharmacological options are in development. When patients cease to respond adequately to optimal medical therapy, cardiac resynchronization therapy has been shown to improve symptoms, reduce hospitalizations, promote reverse remodelling, and decrease mortality. However, challenges remain in identifying the ideal recipients for this therapy. The field of mechanical circulatory support has seen immense growth since the early 2000s, and left ventricular assist devices (LVADs) have transitioned over the past decade from large, pulsatile devices to smaller, more-compact, continuous-flow devices. Infections and haematological issues are still important areas that need to be addressed. Whereas LVADs were once approved only for 'bridge to transplantation', these devices are now used as destination therapy for critically ill patients with HF, allowing these individuals to return to the community. A host of novel strategies, including cardiac contractility modulation, implantable haemodynamic-monitoring devices, and phrenic and vagus nerve stimulation, are under investigation and might have an impact on the future care of patients with chronic HF.
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