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Manohar A, Yang J, Pack JD, Ho G, McVeigh ER. Motion correction of wide-detector 4DCT images for cardiac resynchronization therapy planning. J Cardiovasc Comput Tomogr 2024; 18:170-178. [PMID: 38242778 PMCID: PMC11087942 DOI: 10.1016/j.jcct.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Lead placement at the latest mechanically activated left ventricle (LV) segments is strongly correlated with response to cardiac resynchronization therapy (CRT). We demonstrate the feasibility of a cardiac 4DCT motion correction algorithm (ResyncCT) in estimating LV mechanical activation for guiding lead placement in CRT. METHODS Subjects with full cardiac cycle 4DCT images acquired using a wide-detector CT scanner for CRT planning/upgrade were included. 4DCT images exhibited motion artifact-induced false-dyssynchrony, hindering LV mechanical activation time estimation. Motion-corrupted images were processed with ResyncCT to yield motion-corrected images. Time to onset of shortening (TOS) was estimated in each of 72 endocardial segments. A false-dyssynchrony index (FDI) was used to quantify the extent of motion artifacts in the uncorrected and the ResyncCT images. After motion correction, the change in classification of LV free-wall segments as optimal target sites for lead placement was investigated. RESULTS Twenty subjects (70.7 ± 13.9 years, 6 female) were analyzed. Motion artifacts in the ResyncCT-processed images were significantly reduced (FDI: 28.9 ± 9.3 % vs 47.0 ± 6.0 %, p < 0.001). In 10 (50 %) subjects, ResyncCT motion correction yielded statistically different TOS estimates (p < 0.05). Additionally, 43 % of LV free-wall segments were reclassified as optimal target sites for lead placement after motion correction. CONCLUSIONS ResyncCT significantly reduced motion artifacts in wide-detector cardiac 4DCT images, yielded statistically different time to onset of shortening estimates, and changed the location of optimal target sites for lead placement. These results highlight the potential utility of ResyncCT motion correction in CRT planning when using wide-detector 4DCT imaging.
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Affiliation(s)
- Ashish Manohar
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA; Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - James Yang
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Jed D Pack
- Radiation Systems Lab, GE Global Research, Niskayuna, New York, USA
| | - Gordon Ho
- Department of Medicine, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Elliot R McVeigh
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA; Department of Medicine, Division of Cardiology, University of California San Diego, La Jolla, CA, USA; Department of Radiology, University of California San Diego, La Jolla, CA, USA.
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Aikawa T, Kamada R, Ogino J, Saitou T, Funayama N, Hotta D. Cardiac resynchronization therapy through a subcutaneous tunnel assessed by phase analysis of gated myocardial perfusion SPECT imaging. J Nucl Cardiol 2023; 30:1277-1282. [PMID: 35260966 PMCID: PMC10261224 DOI: 10.1007/s12350-022-02916-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Tadao Aikawa
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan.
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Rui Kamada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Jiro Ogino
- Department of Pathology, JR Sapporo Hospital, Kita-3, Higashi-1, Sapporo, 060-0033, Japan
| | - Toshinori Saitou
- Department of Radiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
| | - Naohiro Funayama
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
| | - Daisuke Hotta
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
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Asensio-Nogueira J, Salgado-Aranda R, Sánchez-Corral E, Fernández-González B, García-Fernández FJ, Martín-González FJ, Villagraz-Tecedor L, Gómez-Llorente M, Álvarez-Calderón M, Pérez-Rivera JÁ. Differences in the prognostic value of the electrocardiographic pattern after cardiac resynchronization therapy according to age. Arch Gerontol Geriatr 2023; 104:104826. [PMID: 36223692 DOI: 10.1016/j.archger.2022.104826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES In this cohort study, we analyzed if a specific pattern in three leads of the electrocardiogram (Rs in V1, Qr in aVL, or rS in I) was associated with outcomes after cardiac resynchronization therapy (CRT) depending on age. METHODS Patients with CRT devices were included from January 2012 to April 2019. We divided the sample into 2 groups, those with age ≥ 75 years old and those younger. The primary endpoint was a composite of all-cause death and heart failure (HF) hospitalization at 1 year. RESULTS We included 111 patients. Patients older than 75 years (26.1%, n = 29) had a significantly higher rate of hypertension and atrial fibrillation and received less frequently optimal medical therapy. The patterns were observed in 32 (39.0%) younger patients and 11 (37.9%) older patients. Patients who presented any of them had a lower incidence of the primary endpoint in the younger group (0 vs. 14%, p = 0.029), but not in the older group (9.1 vs. 27.8%, p = 0.24). The presence of a basal QRS duration greater than 160 ms was associated with a higher rate of the primary endpoint in the elderly (50 vs. 13%, p = 0.015), but not in the younger group (16.7 vs. 7.1%, p = 0.254). CONCLUSIONS The presence of the selected patterns after CRT is associated with a lower incidence of all-cause death and hospitalization for HF in patients younger than 75 years, but not in those older than 75 years. Conversely, baseline QRS duration was associated with worse outcomes in older patients, but not in the younger group.
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Affiliation(s)
- Juan Asensio-Nogueira
- Department of Cardiology, Hospital Universitario de Burgos, Av. Islas Baleares, 3, Burgos 09006, Spain.
| | - Ricardo Salgado-Aranda
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, Madrid 28040, Spain
| | - Ester Sánchez-Corral
- Department of Cardiology, Hospital Universitario de Burgos, Av. Islas Baleares, 3, Burgos 09006, Spain
| | | | | | | | - Lola Villagraz-Tecedor
- Department of Cardiology, Hospital Universitario de Burgos, Av. Islas Baleares, 3, Burgos 09006, Spain
| | - Marta Gómez-Llorente
- Department of Cardiology, Hospital Universitario de Burgos, Av. Islas Baleares, 3, Burgos 09006, Spain
| | - Marcos Álvarez-Calderón
- Department of Cardiology, Hospital Universitario de Burgos, Av. Islas Baleares, 3, Burgos 09006, Spain
| | - José-Ángel Pérez-Rivera
- Department of Cardiology, Hospital Universitario de Burgos, Av. Islas Baleares, 3, Burgos 09006, Spain; Facultad de Ciencias de la Salud, Universidad Isabel I, Calle de Fernán González, 76, Burgos 09003, Spain
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4
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Batra A, Barnard AM, Lott DJ, Willcocks RJ, Forbes SC, Chakraborty S, Daniels MJ, Arbogast J, Triplett W, Henricson EK, Dayan JG, Schmalfuss C, Sweeney L, Byrne BJ, McDonald CM, Vandenborne K, Walter GA. Longitudinal changes in cardiac function in Duchenne muscular dystrophy population as measured by magnetic resonance imaging. BMC Cardiovasc Disord 2022; 22:260. [PMID: 35681116 PMCID: PMC9185987 DOI: 10.1186/s12872-022-02688-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/19/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The lack of dystrophin in cardiomyocytes in Duchenne muscular dystrophy (DMD) is associated with progressive decline in cardiac function eventually leading to death by 20-40 years of age. The aim of this prospective study was to determine rate of progressive decline in left ventricular (LV) function in Duchenne muscular dystrophy (DMD) over 5 years. METHODS Short axis cine and grid tagged images of the LV were acquired in individuals with DMD (n = 59; age = 5.3-18.0 years) yearly, and healthy controls at baseline (n = 16, age = 6.0-18.3 years) on a 3 T MRI scanner. Grid-tagged images were analyzed for composite circumferential strain (ℇcc%) and ℇcc% in six mid LV segments. Cine images were analyzed for left ventricular ejection fraction (LVEF), LV mass (LVM), end-diastolic volume (EDV), end-systolic volume (ESV), LV atrioventricular plane displacement (LVAPD), and circumferential uniformity ratio estimate (CURE). LVM, EDV, and ESV were normalized to body surface area for a normalized index of LVM (LVMI), EDV (EDVI) and ESV (ESVI). RESULTS At baseline, LV ℇcc% was significantly worse in DMD compared to controls and five of the six mid LV segments demonstrated abnormal strain in DMD. Longitudinal measurements revealed that ℇcc% consistently declined in individuals with DMD with the inferior segments being more affected. LVEF progressively declined between 3 to 5 years post baseline visit. In a multivariate analysis, the use of cardioprotective drugs trended towards positively impacting cardiac measures while loss of ambulation and baseline age were associated with negative impact. Eight out of 17 cardiac parameters reached a minimal clinically important difference with a threshold of 1/3 standard deviation. CONCLUSION The study shows a worsening of circumferential strain in dystrophic myocardium. The findings emphasize the significance of early and longitudinal assessment of cardiac function in DMD and identify early biomarkers of cardiac dysfunction to help design clinical trials to mitigate cardiac pathology. This study provides valuable non-invasive and non-contrast based natural history data of cardiac changes which can be used to design clinical trials or interpret the results of current trials aimed at mitigating the effects of decreased cardiac function in DMD.
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Affiliation(s)
- Abhinandan Batra
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Alison M Barnard
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Donovan J Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Rebecca J Willcocks
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Sean C Forbes
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | | | - Michael J Daniels
- Department of Statistics, University of Florida, Gainesville, FL, 32610, USA
| | - Jannik Arbogast
- Department of Physiology and Functional Genomics, University of Florida, 1600 SW Archer RD, M552, P.O. Box 1002754, Gainesville, FL, 32610, USA
| | - William Triplett
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Erik K Henricson
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Sacramento, CA, 95817, USA
| | | | - Carsten Schmalfuss
- Department of Medicine, Cardiology, University of Florida, Gainesville, FL, 32610, USA
| | - Lee Sweeney
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, 32610, USA
| | - Barry J Byrne
- Department of Pediatrics, University of Florida, Gainesville, FL, 32610, USA
| | - Craig M McDonald
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Sacramento, CA, 95817, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, 1600 SW Archer RD, M552, P.O. Box 1002754, Gainesville, FL, 32610, USA.
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Abstract
The role of electromechanical dyssynchrony in heart failure gained prominence in literature with the results of trials of cardiac resynchronization therapy (CRT). CRT has shown to significantly decrease heart failure hospitalization and mortality in heart failure patients with dyssynchrony. Current guidelines recommend the use of electrical dyssynchrony based on a QRS > 150 ms and a left bundle branch block pattern on surface electrocardiogram to identify dyssynchrony in patients who will benefit from CRT implantation. However, predicting response to CRT remains a challenge with nearly one-third of patients gaining no benefit from the device. Multiple echocardiographic measures of mechanical dyssynchrony have been studied over the past two decade. However, trials where mechanical dyssynchrony used as an additional or lone criteria for CRT failed to show any benefit in the response to CRT. This shows that a deeper understanding of cardiac mechanics should be applied in the assessment of dyssynchrony. This review discusses the evolving role of imaging techniques in assessing cardiac dyssynchrony and their application in patients considered for device therapy.
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6
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Daubert MA, Tailor T, James O, Shaw LJ, Douglas PS, Koweek L. Multimodality cardiac imaging in the 21st century: evolution, advances and future opportunities for innovation. Br J Radiol 2020; 94:20200780. [PMID: 33237824 DOI: 10.1259/bjr.20200780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular imaging has significantly evolved since the turn of the century. Progress in the last two decades has been marked by advances in every modality used to image the heart, including echocardiography, cardiac magnetic resonance, cardiac CT and nuclear cardiology. There has also been a dramatic increase in hybrid and fusion modalities that leverage the unique capabilities of two imaging techniques simultaneously, as well as the incorporation of artificial intelligence and machine learning into the clinical workflow. These advances in non-invasive cardiac imaging have guided patient management and improved clinical outcomes. The technological developments of the past 20 years have also given rise to new imaging subspecialities and increased the demand for dedicated cardiac imagers who are cross-trained in multiple modalities. This state-of-the-art review summarizes the evolution of multimodality cardiac imaging in the 21st century and highlights opportunities for future innovation.
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Affiliation(s)
- Melissa A Daubert
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Tina Tailor
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Olga James
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Leslee J Shaw
- Department of Radiology, Cornell Medical Center, New York, New York, USA
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lynne Koweek
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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Huang HC, Chien KL, Chang YC, Lin LY, Wang J, Liu YB. Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block. J Cardiovasc Electrophysiol 2020; 31:1770-1778. [PMID: 32275338 DOI: 10.1111/jce.14488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study aimed to investigate the association between T-wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T-wave morphology for response to cardiac resynchronization therapy (CRT). METHODS AND RESULTS We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS-to-T angle (TCRT), T-wave morphology dispersion (TMD), T-wave loop area (PL), and T-wave residuum (TWR), were reconstructed from digital standard 12-lead electrocardiograms by T-wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end-systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF < 40%. Among 40 patients who underwent CRT, those with a larger TMD (P = .007), larger PL (P = .025), and more negative TCRT (P = .015) had better response to CRT. A large TMD (P = .018) and large PL (P = .003) were also independent predictors of the clinical outcome endpoint. CONCLUSIONS Increases in repolarization heterogeneity in patients with cLBBB are associated with impaired LVEF. A large TMD and large PL may be useful as additional predictors of response to CRT, improving patient selection for CRT.
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Affiliation(s)
- Hui-Chun Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Institute of Epidemiology, College of Public Health, Taipei, Taiwan
| | - Yi-Chung Chang
- Institute of Communication Engineering, National Taiwan University, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology, College of Public Health, Taipei, Taiwan
| | - Yen-Bin Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
Left bundle branch block may be due to conduction system degeneration or a reflection of myocardial pathology. Left bundle branch block may also develop following aortic valve disease or cardiac procedures. Patients with heart failure with reduced ejection fraction and left bundle branch block may respond positively to cardiac resynchronization therapy. Lead placement via the coronary sinus is the mainstay approach of cardiac resynchronization therapy. However, other options, including physiological pacing, are being explored. In this review, we summarize the salient pathophysiologic and clinical aspects of left bundle branch block, as well as current and future strategies for management.
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Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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9
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Dal Ferro M, De Paris V, Collia D, Stolfo D, Caiffa T, Barbati G, Korcova R, Pinamonti B, Zovatto L, Zecchin M, Sinagra G, Pedrizzetti G. Left Ventricular Response to Cardiac Resynchronization Therapy: Insights From Hemodynamic Forces Computed by Speckle Tracking. Front Cardiovasc Med 2019; 6:59. [PMID: 31139633 PMCID: PMC6527774 DOI: 10.3389/fcvm.2019.00059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
Aims: Despite continuous efforts in improving the selection process, the rate of non-responders to cardiac resynchronization therapy (CRT) remains high. Recent studies on intraventricular blood flow suggested that the alignment of hemodynamic forces (HDFs) may be a reproducible biomarker of mechanical dyssynchrony. We aimed to explore the relationship between pacing-induced realignment of HDFs and positive response to CRT. Methods and results: We retrospectively analyzed 38 patients from the CRT database of our institution fulfilling the inclusion criteria for HDFs-related echocardiographic assessment early pre and post CRT implantation, with available mid-term follow-up (≥ 6 months) evaluation. Standard echocardiographic and deformation parameters early pre and post CRT implantation were integrated with the measurement of HFDs through novel methods based on speckle-tracking analysis. At midterm follow-up 71% of patients were classified as responders (reduction of Left Ventricular Systolic Volume Indexed ≥ 15%). Patients did not display significant changes between close evaluations pre and post-implant in terms of ejection fraction and strain metrics. A significant reduction of the ratio between the amplitudes of transversal and longitudinal force components was found. The variation of this ratio strongly correlates (R2 =0.60) with Left Ventricular (LV) end-systolic volume variation at mid-term follow up. Conclusion: Pacing-induced realignment of HDFs is associated with CRT efficacy at follow up. These preliminary results claim for dedicated prospective clinical studies testing the potential impact of HDFs study for patient selection and pacing optimization in CRT.
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Affiliation(s)
- Matteo Dal Ferro
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Valerio De Paris
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Dario Collia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Thomas Caiffa
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Renata Korcova
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Bruno Pinamonti
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Luigino Zovatto
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Ospedaliera Universitaria Integrata of Trieste, Trieste, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
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Höke U, Bax JJ, Delgado V, Ajmone Marsan N. Assessment of left ventricular dyssynchrony by three-dimensional echocardiography: Prognostic value in patients undergoing cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2018; 29:780-787. [PMID: 29377419 DOI: 10.1111/jce.13445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/10/2018] [Accepted: 01/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Systolic dyssynchrony index (SDI) using three-dimensional echocardiography (3DE) was shown to be a reliable measure of left ventricular (LV) dyssynchrony. However, the prognostic value of SDI on long-term outcomes after cardiac resynchronization therapy (CRT) remains unknown. METHODS AND RESULTS A total of 414 patients (mean age 67 ± 10 years, 60% ischemic etiology) with 3DE evaluation before CRT implantation were included. SDI was evaluated as continuous value and in quartiles. The study endpoint was combined all-cause mortality, heart transplantation, and LV assist device implantation. At baseline, median SDI was 8.0% (IQR 5.6-11.3%). During a median follow-up of 45 months (IQR 25-59 months), the endpoint was observed in 94 (23%) patients. SDI was independently associated with the endpoint together with ischemic etiology, diabetes, and renal function (HR 0.914, P = 0.003) after adjustment for age, atrial fibrillation, hemoglobin level, NYHA functional class, and posterolateral LV lead position. Patients from the 1st, 2nd, and 3rd SDI quartiles showed similar survival and superior as compared to the 4th quartile with the lowest SDI values (≤5.5%; χ²: 30.4, log-rank P < 0.001). From receiver operating characteristic curve analysis, the optimal SDI cut-off value associated with the endpoint was >6.8% (area under the curve 0.634). Finally, a subgroup analysis (293 patients) demonstrated that a more pronounced reduction in SDI immediately after CRT (resynchronization) was independently associated with superior survival (HR 0.461, P = 0.011) after adjustment for prognostic relevant parameters. CONCLUSION SDI is independently associated with long-term prognosis after CRT and might therefore be important to optimize risk-stratification in these patients.
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Affiliation(s)
- Ulas Höke
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.,Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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11
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Höke U, Bax JJ, Ajmone Marsan N, Delgado V. Echocardiography in Cardiac Resynchronization Therapy. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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'Optimized' LV only pacing using a dual chamber pacemaker as a cost effective alternative to CRT. Indian Pacing Electrophysiol J 2017; 17:72-77. [PMID: 29073000 PMCID: PMC5478914 DOI: 10.1016/j.ipej.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Cardiac Resynchronization therapy (CRT) remains largely under-used in developing countries owing to the high cost of therapy. In this pilot study, we explore ‘optimized’ Left Ventricle Only Pacing (LVOP) as a cost effective alternative to cardiac resynchronization therapy in selected patients with heart failure. Hypothesis In economically poorer patients with heart failure, left bundle branch block (LBBB) and intact AV node conduction, synchronization can be obtained using a dual chamber pacemaker (leads in right atrium and Left ventricle) with the help of 2D strain imaging. Methods and results 4 patients underwent LVOP for symptomatic heart failure. Post procedure ‘optimization’ was done using 12 lead electrocardiography and 2D- Strain imaging. Difference between Time to Peak longitudinal strain and Aortic valve Closure (Diff TPL-AC) was calculated for each segment at different AV delays and the AV delay with the smallest Diff TPL-AC was programmed. The mean AV delay that resulted in electrical and mechanical synchrony was 150 ms. After a mean follow up of 6 months, all patients had improved by at least 1 NYHA class. The mean reduction in QRS duration post procedure was −54.5 ± 22.82 ms and the mean improvement in EF was 7 ± 2.75%. Conclusion Optimized LVOP using 2D strain and ECG can be a cost-effective alternative to CRT in patients with LBBB, heart failure and normal AV node conduction.
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13
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Zhou W, Jiang Z, Chen J, Garcia EV, Li D. Development and validation of a phase analysis tool to measure interventricular mechanical dyssynchrony from gated SPECT MPI. J Nucl Cardiol 2017; 24:1680-1686. [PMID: 27225514 PMCID: PMC10955150 DOI: 10.1007/s12350-016-0503-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study is to develop a right-ventricular (RV) phase analysis tool which when coupled with our left ventricular (LV) phase analysis tool can provide measurement of the interventricular mechanical dyssynchrony from gated SPECT myocardial perfusion imaging (MPI), and validate the tool by electrocardiography (ECG). METHODS For each patient, short-axis LV and RV SPECT MPI images were input into an automatic sampling algorithm to generate the 3D maximal count circumferential profiles for both LV and RV in each cardiac frame. Subsequently, the samples of LV and RV were separately used by our phase analysis tool based on the first-harmonic Fourier approximation to calculate the contraction onset for each sample. The difference between contraction onsets of the middle LV free wall and middle LV septal wall represented the LV contraction delay; the difference between contraction onsets of the middle RV free wall and middle RV septal wall represented the RV contraction delay. The difference between the LV and RV contraction delays represented the interventricular contraction delay, which was compared with the interventricular conduction delay classified by ECG to validate the concordance of interventricular mechanical and electrical dyssynchrony. Sixty-one bundle branch block (BBB) patients with ischemic-dilated cardiomyopathy (26, 42.6%) or non-ischemic-dilated cardiomyopathy (35, 57.4%), who underwent 12-lead surface ECG and gated resting Tc-99m sestamibi SPECT, were retrospectively analyzed in this study. RESULTS In the 30 patients with left bundle branch block (LBBB) by ECG, there were 27 patients whose LV contracted later than the RV according to SPECT; and in the 31 patients with right bundle branch block (RBBB) by ECG, there were 26 patients whose LV contracted earlier than the RV according to SPECT. In total, an agreement rate of 86.9% (53 of 61) was achieved between SPECT and ECG. The Kappa agreement rate was 73.8% (95% confidence interval 0.57-0.91). CONCLUSION The preliminary results showed promise for the measurement of interventricular mechanical dyssynchrony in BBB patients with dilated cardiomyopathy using our phase analysis tool.
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Affiliation(s)
- Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
| | - Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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14
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Robust and automatic diagnosis of the intraventricular mechanical dyssynchrony for the left ventricle in cardiac magnetic resonance images. Int J Comput Assist Radiol Surg 2017; 12:1471-1480. [DOI: 10.1007/s11548-017-1574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
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15
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Surkova E, Badano LP, Bellu R, Aruta P, Sambugaro F, Romeo G, Migliore F, Muraru D. Left bundle branch block: from cardiac mechanics to clinical and diagnostic challenges. Europace 2017; 19:1251-1271. [DOI: 10.1093/europace/eux061] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
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16
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Abstract
Dyssynchronous contraction of the ventricle significantly worsens morbidity and mortality in patients with heart failure (HF). Approximately one-third of patients with HF have cardiac dyssynchrony and are candidates for cardiac resynchronization therapy (CRT). The initial understanding of dyssynchrony and CRT was in terms of global mechanics and hemodynamics, but lack of clinical benefit in a sizable subgroup of recipients who appear otherwise appropriate has challenged this paradigm. This article reviews current understanding of these cellular and subcellular mechanisms, arguing that these aspects are key to improving CRT use, as well as translating its benefits to a wider HF population.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA.
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA
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17
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Végh EM, Kandala J, Januszkiewicz L, Ren J, Miller A, Orencole M, Blendea D, Merkely B, Gellér L, Singh JP, Borgquist R. A new simplified electrocardiographic score predicts clinical outcome in patients treated with CRT. Europace 2017; 20:492-500. [DOI: 10.1093/europace/euw382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/31/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eszter M Végh
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
- Semmelweis University, Heart and Vascular Center, Városmajor 68, 1122 Budapest, Hungary
| | - Jagdesh Kandala
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Lukasz Januszkiewicz
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Jen Ren
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Alexandra Miller
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Mary Orencole
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Dan Blendea
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Béla Merkely
- Semmelweis University, Heart and Vascular Center, Városmajor 68, 1122 Budapest, Hungary
| | - László Gellér
- Semmelweis University, Heart and Vascular Center, Városmajor 68, 1122 Budapest, Hungary
| | - Jagmeet P Singh
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Rasmus Borgquist
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Cardiology, Lund, Sweden
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18
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Mada RO, Lysyansky P, Duchenne J, Beyer R, Mada C, Muresan L, Rosianu H, Serban A, Winter S, Fehske W, Stankovic I, Voigt JU. New Automatic Tools to Identify Responders to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2016; 29:966-972. [DOI: 10.1016/j.echo.2016.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 10/21/2022]
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19
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Gąsior Z, Płońska-Gościniak E, Kułach A, Wita K, Mizia-Stec K, Szwed H, Kasprzak J, Tomaszewski A, Sinkiewicz W, Wojciechowska C. Impact of septal flash and left ventricle contractile reserve on positive remodeling during 1 year cardiac resynchronization therapy: the multicenter ViaCRT study. Arch Med Sci 2016; 12:349-52. [PMID: 27186179 PMCID: PMC4848364 DOI: 10.5114/aoms.2016.59260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/24/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has been shown to improve outcomes in patients with systolic heart failure (HFREF). However, the relatively high non-responder rate results in a need for more precise qualification for CRT. The ViaCRT study was designed to determine the role of contractile reserve and dyssynchrony parameters in predicting CRT response. The purpose of this analysis was to determine the effect of baseline septal flash and contractile reserve (CR) on clinical and echocardiographic parameters of response to CRT in 12-month follow-up. MATERIAL AND METHODS One hundred thirty-three guideline-selected CRT candidates (both ischemic and non-ischemic heart failure with reduced ejection fraction) were enrolled in the study. Baseline study population characteristics were: left ventricle ejection fraction (LVEF) 25 ±6%, QRS 165 ±25 ms, NYHA class III (90%) and IV (10%). RESULTS In subjects with septal flash (SF) registered before CRT implantation improvement in LVEF (14 ±2% vs. 8 ±1%, p < 0.05) and left ventricle (LV) systolic (63 ±10 ml vs. 36 ±6 ml, p < 0.05) and diastolic (46 ±10 ml vs. 32 ±7, p < 0.05) volumes was more pronounced than in patients without SF. In patients with CR (defined as LVEF increase by 20% or 4 viable segments) improvement in echo parameters was not significantly different then in the CR- group. Neither SF nor CR was associated with improvement in NYHA class. Subgroup analysis revealed that only in non-ischemic HF patients is presence of septal flash associated with LV function improvement after CRT. CONCLUSIONS In non-ischemic HF patients septal flash is a helpful parameter in prediction of LV remodeling after 12 months of resynchronization therapy.
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Affiliation(s)
- Zbigniew Gąsior
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Andrzej Kułach
- 2 Department of Cardiology, SPSK No. 7, Medical University of Silesia, Katowice, GCM, Poland
| | - Krystian Wita
- 1 Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Hanna Szwed
- 2 Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | | | | | - Władysław Sinkiewicz
- 2 Department of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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20
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Voskoboinik A, McGavigan AD, Mariani JA. Cardiac resynchronisation therapy in 2015: keeping up with the pace. Intern Med J 2016; 46:255-65. [DOI: 10.1111/imj.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Voskoboinik
- Department of Cardiology; Western Hospital; Melbourne Victoria Australia
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
| | - A. D. McGavigan
- Department of Cardiovascular Medicine; Adelaide South Australia Australia
| | - J. A. Mariani
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Cardiac Investigation Unit; St Vincent' Hospital; Melbourne Victoria Australia
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21
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Shanks M, Delgado V, Bax JJ. Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy. J Atr Fibrillation 2016; 8:1362. [PMID: 27909478 DOI: 10.4022/jafib.1362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 12/12/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established therapy for heart failure patients who remain symptomatic despite optimal medical therapy, have reduced left ventricular ejection fraction (<35%) and wide QRS duration (>120 ms), preferably with left bundle branch block morphology. The response to CRT depends on the cardiac substrate: presence of correctable left ventricular mechanical dyssynchrony, presence of myocardial fibrosis (scar) and position of the left ventricular pacing lead. Patients with non-ischemic cardiomyopathy have shown higher response rates to CRT compared with patients with ischemic cardiomyopathy. Differences in myocardial substrate may partly explain this disparity. Multimodality imaging plays an important role to assess the cardiac substrate and the pathophysiological determinants of response to CRT.
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Affiliation(s)
- Miriam Shanks
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
| | - Victoria Delgado
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
| | - Jeroen J Bax
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
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22
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Abstract
Dyssynchronous contraction of the ventricle significantly worsens morbidity and mortality in patients with heart failure (HF). Approximately one-third of patients with HF have cardiac dyssynchrony and are candidates for cardiac resynchronization therapy (CRT). The initial understanding of dyssynchrony and CRT was in terms of global mechanics and hemodynamics, but lack of clinical benefit in a sizable subgroup of recipients who appear otherwise appropriate has challenged this paradigm. This article reviews current understanding of these cellular and subcellular mechanisms, arguing that these aspects are key to improving CRT use, as well as translating its benefits to a wider HF population.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA.
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA
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23
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Abstract
Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.
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24
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Hasselberg NE, Haugaa KH, Bernard A, Ribe MP, Kongsgaard E, Donal E, Edvardsen T. Left ventricular markers of mortality and ventricular arrhythmias in heart failure patients with cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2015; 17:343-50. [PMID: 26164406 PMCID: PMC4750507 DOI: 10.1093/ehjci/jev173] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/12/2015] [Indexed: 01/04/2023] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure. However, prediction of the outcome remains difficult. We aimed to investigate for echocardiographic predictors of ventricular arrhythmias and fatal outcome and to explore how myocardial function is changed by biventricular pacing in heart failure. Methods and results We prospectively included 170 heart failure patients (66 ± 10 years, New York Heart Association class 2.8 ± 0.5, 48% ischaemic cardiomyopathy) and recorded ventricular arrhythmias and fatal end point defined as death, heart transplantation, or left ventricular assist device implantation during 2 years. Two-dimensional echocardiography was performed before and 6 months after CRT implantation. CRT response was defined as ≥15% reduction in end-systolic volume at 6 months. Speckle-tracking technique was performed to assess longitudinal and circumferential left ventricular function, defined as global longitudinal (GLS) and circumferential strain (GCS), and to assess mechanical dyssynchrony, defined as mechanical dispersion. GLS before CRT was a predictor of fatal end point independently of CRT response [hazard ratio, HR 1.14 (1.02–1.27), P = 0.02]. Patients with GLS better than −8.3% showed event-free survival benefit (log rank, P < 0.001). Mechanical dispersion at 6 months was an independent predictor of ventricular arrhythmias [HR 1.20 (1.06–1.35), P = 0.005]. CRT responders (59%) had improvement of both GLS and GCS. Conclusion In heart failure patients with CRT, worse longitudinal function before CRT was an important predictor of fatal outcome during 2 years, independently of CRT response. Mechanical dispersion at 6 months was a strong predictor of ventricular arrhythmias. CRT response by reverse remodelling was dependent on improvement of both longitudinal and circumferential function.
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Affiliation(s)
- Nina E Hasselberg
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway University of Oslo, Oslo, Norway Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway University of Oslo, Oslo, Norway Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anne Bernard
- LTSI, INSERM UMR 1099-Université Rennes-1, CIC-IT 804 CHU RENNES, Rennes, France
| | - Margareth P Ribe
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Kongsgaard
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway University of Oslo, Oslo, Norway Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erwan Donal
- LTSI, INSERM UMR 1099-Université Rennes-1, CIC-IT 804 CHU RENNES, Rennes, France
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway University of Oslo, Oslo, Norway Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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25
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Nappi C, Acampa W, Pellegrino T, Petretta M, Cuocolo A. Beyond ultrasound: advances in multimodality cardiac imaging. Intern Emerg Med 2015; 10:9-20. [PMID: 25037458 DOI: 10.1007/s11739-014-1106-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Abstract
The rapid technological evolution accomplished in noninvasive cardiac imaging techniques over the past few decades has provided physicians with a large armamentarium for the evaluation of patients with known or suspected coronary heart disease. Noninvasive assessment of coronary artery calcium or noninvasive coronary angiography may be performed using computed tomography or magnetic resonance imaging. These techniques evaluate the presence of atherosclerosis rather than ischemia. Conversely, nuclear cardiology is the most widely used noninvasive approach for the assessment of myocardial perfusion and function. These techniques coupled with the development of dedicated image fusion software packages to merge data sets from different modalities have paved the way for hybrid imaging. This article provides a description of the available noninvasive imaging techniques in the assessment of coronary anatomy, myocardial perfusion, and cardiac function in patients with known or suspected coronary heart disease.
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Affiliation(s)
- Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
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26
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Garbi M, McDonagh T, Cosyns B, Bucciarelli-Ducci C, Edvardsen T, Kitsiou A, Nieman K, Lancellotti P. Appropriateness criteria for cardiovascular imaging use in heart failure: report of literature review. Eur Heart J Cardiovasc Imaging 2014; 16:147-53. [PMID: 25550363 DOI: 10.1093/ehjci/jeu299] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Imaging Task Force appointed by the European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging (EACVI) identified the need to develop appropriateness criteria for the use of cardiovascular imaging in heart failure as a result of continuously increasing demand for imaging in diagnosis, definition of aetiology, follow-up, and treatment planning. This article presents the report of literature review performed in order to inform the process of definition of clinical indications and to aid the decisions of the appropriateness criteria voting panel. The report is structured according to identified common heart failure clinical scenarios.
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Affiliation(s)
- Madalina Garbi
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Theresa McDonagh
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Bernard Cosyns
- Universitair Ziekenhuis van Brussel, CHVZ and ICMI Laboratory, CHIREC, Brussels, Belgium
| | - Chiara Bucciarelli-Ducci
- Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Norway
| | | | - Koen Nieman
- Department of Cardiology and Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Patrizio Lancellotti
- Department of GIGA Cardiovascular Sciences, Heart Valve Clinic, Department of Cardiology, University of Liège Hospital, University Hospital SartTilman, Liège, Belgium Department of GVM Care and Research, Bologna, Italy
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Abstract
Magnetic resonance assessment of regional myocardial function is a novel potentially important tool for early identification of cardiac pathology. Many cardiac magnetic resonance techniques have been developed for detection and quantification of regional strain abnormalities including steady-state free-precession CINE, tagging, displacement encoding with stimulated echoes, strain encoding imaging, and feature tracking. Potential clinical applications of magnetic resonance strain imaging include early detection of systolic dysfunction in heart failure patients with both ischemic and nonischemic etiologies.
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28
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Assadian Rad M, Tabarzan Baboli N, Barzigar A, Keirkhah J, Soltanipour S, Bonakdar HR, Mirbolouk F, Moladoust H. The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy. Anatol J Cardiol 2014; 15:204-8. [PMID: 25333982 PMCID: PMC5337055 DOI: 10.5152/akd.2014.5307] [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: 01/29/2023] Open
Abstract
Objective: Cardiac resynchronization therapy (CRT) is introduced as a promising therapeutic option in heart failure (HF) patients with ventricular dyssynchrony. The challenge, however, is identifying the patients who are suitable candidates for this procedure. Fragmented QRS (fQRS) is associated with subendocardial fibrosis and myocardial scars. In this study, we aimed to evaluate the role of fragmented QRS complex on a routine 12-lead ECG as a predictor of response to CRT. Methods: Sixty-five consecutive patients with HF who underwent CRT, were studied. Patients’ resting 12-lead ECGs were analyzed to find presence of fQRS by a cardiologist. Echocardiographic response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume (LVESV) after CRT implantation. Response to CRT was compared between patients with and without fQRS. Results: The study group included 27 women (41.5%) and 38 men (58.5%) with a mean (±SD) age of 62±12 years. 27 patients (41.5%) had fQRS in their basal ECGs. Totally 46 patients (70.8%) responded to CRT in a way that the mean left ventricular ejection fraction (%) significantly increased, and left ventricular end diastolic volume (LVEDV) significantly decreased after CRT (p<0.001 and p=0.001 respectively). In multivariate logistic analysis, lack of fQRS was found to be a predictor of response to CRT (OR: 4.553, 95% CI: 1.345-15.418, p=0.015). Conclusion: We showed that the fQRS complex, as a sign of myocardial scar, predicts non-responsiveness to CRT. Therefore, fQRS may help selecting of CRT candidates.
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Affiliation(s)
- Mohammad Assadian Rad
- Cardiovascular Research Center, Faculty of Medicine, Guilan University of Medical Sciences; Rasht-Iran.
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29
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Sade LE, Saba S, Marek JJ, Onishi T, Schwartzman D, Adelstein EC, Soman P, Gorcsan J. The Association of Left Ventricular Lead Position Related to Regional Scar by Speckle-Tracking Echocardiography with Clinical Outcomes in Patients Receiving Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2014; 27:648-56. [DOI: 10.1016/j.echo.2014.01.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Indexed: 10/25/2022]
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30
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Haugaa KH, Marek JJ, Ahmed M, Ryo K, Adelstein EC, Schwartzman D, Saba S, Gorcsan J. Mechanical dyssynchrony after cardiac resynchronization therapy for severely symptomatic heart failure is associated with risk for ventricular arrhythmias. J Am Soc Echocardiogr 2014; 27:872-9. [PMID: 24798865 DOI: 10.1016/j.echo.2014.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risk factors for ventricular arrhythmias after cardiac resynchronization defibrillator therapy (CRT-D) for severely symptomatic heart failure are of clinical importance but are not clearly defined. The objective of this study was to test the hypothesis that mechanical dyssynchrony after CRT-D is a risk factor for ventricular arrhythmias. METHODS A total of 266 consecutive CRT-D patients with class III or IV heart failure, QRS duration ≥120 msec, and ejection fractions ≤ 35% were prospectively studied. Dyssynchrony was assessed before and 6 months after CRT-D using speckle-tracking radial strain anteroseptal-to-posterior wall delay, predefined as ≥130 msec. Ventricular arrhythmias were predefined as appropriate antitachycardia pacing or shock, and the combined end point of ventricular arrhythmias, death, transplantation, or left ventricular assist device implantation was followed over 2 years. RESULTS Of the initial 266 patients, 11 died, five underwent transplantation, three received left ventricular assist devices before their 6-month echocardiographic examinations, 19 (7%) had inadequate speckle-tracking at 6-month follow-up, and 27 (10%) were lost to follow-up. Accordingly, the study group consisted of 201 patients. Dyssynchrony after CRT-D was observed in 79 (39%) and was associated with a significantly higher ventricular arrhythmic event rate: 21% (P < .001) with persistent dyssynchrony and 35% (P < .001) with new dyssynchrony, compared with 8% with no dyssynchrony after CRT-D. The combined end point of ventricular arrhythmias, death, transplantation, or left ventricular assist device implantation was significantly associated with dyssynchrony after CRT-D (hazard ratio, 2.53; 95% confidence interval, 1.49-4.28; P = .001). Dyssynchrony after CRT-D was associated with ventricular arrhythmias or death in patient subgroups by cardiomyopathy type, QRS width, and morphology (P < .05 for all). CONCLUSIONS Persistent or new radial dyssynchrony after CRT-D in severely symptomatic patients with heart failure with widened QRS complexes and reduced ejection fractions was associated with an increased rate of ventricular arrhythmias or death and appears to be a marker for a less favorable prognosis.
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Affiliation(s)
| | - Josef J Marek
- The University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Keiko Ryo
- The University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Samir Saba
- The University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Gorcsan
- The University of Pittsburgh, Pittsburgh, Pennsylvania.
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Myocardial motion and deformation patterns in an experimental swine model of acute LBBB/CRT and chronic infarct. Int J Cardiovasc Imaging 2014; 30:875-87. [DOI: 10.1007/s10554-014-0403-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
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Petretta M, Petretta A, Pellegrino T, Nappi C, Cantoni V, Cuocolo A. Role of nuclear cardiology for guiding device therapy in patients with heart failure. World J Meta-Anal 2014; 2:1-16. [DOI: 10.13105/wjma.v2.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/20/2013] [Accepted: 12/19/2013] [Indexed: 02/05/2023] Open
Abstract
Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiology and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardiology to guide cardiac resynchronization therapy (CRT) and to select patients for implantable cardioverter defibrillators (ICD). Left ventricular synchrony may be assessed by radionuclide angiography or gated single-photon emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using positron emission tomography and could improve conventional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomography/computed tomography approach for assessing myocardial viability, identifying the location of biventricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Finally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore potentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better define the role of nuclear cardiology for guiding device therapy in patients with heart failure.
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Francone M. Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance. ISRN RADIOLOGY 2014; 2014:365404. [PMID: 24967294 PMCID: PMC4045555 DOI: 10.1155/2014/365404] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 01/07/2023]
Abstract
Dilated cardiomyopathy (DCM) represents the final common morphofunctional pathway of various pathological conditions in which a combination of myocyte injury and necrosis associated with tissue fibrosis results in impaired mechanical function. Recognition of the underlying aetiology of disease and accurate disease monitoring may be crucial to individually optimize therapeutic strategies and stratify patient's prognosis. In this regard, CMR has emerged as a new reference gold standard providing important information for differential diagnosis and new insight about individual risk stratification. The present review article will focus on the role of CMR in the evaluation of present condition, analysing respective strengths and limitations in the light of current literature and technological developments.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324 00161 Rome, Italy
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Bhatia KK, Rao A, Price AN, Wolz R, Hajnal JV, Rueckert D. Hierarchical manifold learning for regional image analysis. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:444-461. [PMID: 24235274 DOI: 10.1109/tmi.2013.2287121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a novel method of hierarchical manifold learning which aims to automatically discover regional properties of image datasets. While traditional manifold learning methods have become widely used for dimensionality reduction in medical imaging, they suffer from only being able to consider whole images as single data points. We extend conventional techniques by additionally examining local variations, in order to produce spatially-varying manifold embeddings that characterize a given dataset. This involves constructing manifolds in a hierarchy of image patches of increasing granularity, while ensuring consistency between hierarchy levels. We demonstrate the utility of our method in two very different settings: 1) to learn the regional correlations in motion within a sequence of time-resolved MR images of the thoracic cavity; 2) to find discriminative regions of 3-D brain MR images associated with neurodegenerative disease.
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Abstract
Patients with heart failure and decreased function frequently develop discoordinate contraction because of electric activation delay. Often termed dyssynchrony, this further decreases systolic function and chamber efficiency and worsens morbidity and mortality. In the mid- 1990s, a pacemaker-based treatment termed cardiac resynchronization therapy (CRT) was developed to restore mechanical synchrony by electrically activating both right and left sides of the heart. It is a major therapeutic advance for the new millennium. Acute chamber effects of CRT include increased cardiac output and mechanical efficiency and reduced mitral regurgitation, whereas reduction in chamber volumes ensues more chronically. Patient candidates for CRT have a prolonged QRS duration and discoordinate wall motion, although other factors may also be important because ≈30% of such selected subjects do not respond to the treatment. In contrast to existing pharmacological inotropes, CRT both acutely and chronically increases cardiac systolic function and work, yet it also reduces long-term mortality. Recent studies reveal unique molecular and cellular changes from CRT that may also contribute to this success. Heart failure with dyssynchrony displays decreased myocyte and myofilament function, calcium handling, β-adrenergic responsiveness, mitochondrial ATP synthase activity, cell survival signaling, and other changes. CRT reverses many of these abnormalities often by triggering entirely new pathways. In this review, we discuss chamber, circulatory, and basic myocardial effects of dyssynchrony and CRT in the failing heart, and we highlight new research aiming to better target and implement CRT, as well as leverage its molecular effects.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Stankovic I, Aarones M, Smith HJ, Voros G, Kongsgaard E, Neskovic AN, Willems R, Aakhus S, Voigt JU. Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy. Eur Heart J 2013; 35:48-55. [DOI: 10.1093/eurheartj/eht294] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zhang H, Abiose AK, Gupta D, Campbell DN, Martins JB, Sonka M, Wahle A. Novel indices for left-ventricular dyssynchrony characterization based on highly automated segmentation from real-time 3-d echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:72-88. [PMID: 23141901 PMCID: PMC3513930 DOI: 10.1016/j.ultrasmedbio.2012.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 06/25/2012] [Accepted: 08/23/2012] [Indexed: 06/01/2023]
Abstract
Cardiac resynchronization therapy (CRT) using a biventricular pacemaker is an invasive and expensive treatment option for left ventricular mechanical dyssynchrony (LVMD). The CRT candidate selection is a crucial issue due to the unreliability of the current standard CRT indicators. Real-time three-dimensional (3-D) echocardiography (RT3DE) provides four-dimensional (4-D) (3-D+time) information about the LV and is suitable for LVMD assessment. In this article, the complex left ventricle (LV) shape and motion of 50 RT3DE datasets are represented by novel 4-D descriptors - 4-D sphericity, volume and shape, from which novel indices were derived by principal component analysis (PCA) and subsequently analyzed by a support vector machine (SVM) classifier to assess their capability of LVMD characterization and CRT outcome prediction. These novel indices outperformed clinical indices and have promising capabilities in disease characterization and great potential in CRT outcome prediction. To enable efficient quantitative RT3DE analysis, a segmentation method was developed to combine the powers of active shape models and optimal graph search. Various aspects of the method were designed to handle varying RT3DE image quality among datasets and LV segments. An application with graphical user interface was developed to provide the user with simple and intuitive control. The developed method was robust to inter-observer variability and produced very good accuracy - 3.2±1.1 mm absolute surface positioning error, <1 mm mean signed error and <5% mean volume difference. The computer method's classification performance was compared with the independent standard, showing that the 4-D shape modal indices were not only the most capable of all tested options when employed for disease characterization but also the least sensitive to segmentation imperfections.
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Affiliation(s)
- Honghai Zhang
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA 52242, USA
| | - Ademola K. Abiose
- Department of Internal Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Dipti Gupta
- Department of Internal Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Dwayne N. Campbell
- Department of Internal Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - James B. Martins
- Department of Internal Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Milan Sonka
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA 52242, USA
| | - Andreas Wahle
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA 52242, USA
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Donal E, Bernard A, Daubert JC. Will mechanical dyssynchrony one day impact our management of chronic heart failure patients? Eur Heart J Cardiovasc Imaging 2012; 14:93-4. [PMID: 22918404 DOI: 10.1093/ehjci/jes170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Constrained manifold learning for the characterization of pathological deviations from normality. Med Image Anal 2012; 16:1532-49. [PMID: 22906821 DOI: 10.1016/j.media.2012.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 05/30/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
Abstract
This paper describes a technique to (1) learn the representation of a pathological motion pattern from a given population, and (2) compare individuals to this population. Our hypothesis is that this pattern can be modeled as a deviation from normal motion by means of non-linear embedding techniques. Each subject is represented by a 2D map of local motion abnormalities, obtained from a statistical atlas of myocardial motion built from a healthy population. The algorithm estimates a manifold from a set of patients with varying degrees of the same disease, and compares individuals to the training population using a mapping to the manifold and a distance to normality along the manifold. The approach extends recent manifold learning techniques by constraining the manifold to pass by a physiologically meaningful origin representing a normal motion pattern. Interpolation techniques using locally adjustable kernel improve the accuracy of the method. The technique is applied in the context of cardiac resynchronization therapy (CRT), focusing on a specific motion pattern of intra-ventricular dyssynchrony called septal flash (SF). We estimate the manifold from 50 CRT candidates with SF and test it on 37 CRT candidates and 21 healthy volunteers. Experiments highlight the relevance of non-linear techniques to model a pathological pattern from the training set and compare new individuals to this pattern.
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Abstract
'Multimodality' imaging--the side-by-side interpretation of data obtained from various noninvasive imaging techniques, such as echocardiography, radionuclide techniques, multidetector CT (MDCT), and MRI--allows anatomical, morphological, and functional data to be combined, increases diagnostic accuracy, and improves the efficacy of cardiovascular interventions and clinical outcomes. During the past decade, advances in software and hardware have allowed co-registration of various imaging modalities, resulting in cardiac 'hybrid' or 'fusion' imaging. In this Review, we discuss the roles of both multimodality and hybrid imaging in three broad areas of cardiology--coronary artery disease (CAD), heart failure, and valvular heart disease. In the evaluation of CAD, integration of either single-photon emission computed tomography (SPECT) or PET with CT coronary angiography provides both morphological and functional data in a single procedure. Accordingly, the functional consequences (myocardial hypoperfusion on SPECT or PET) of anatomical pathology (coronary anatomy on MDCT or MRI) can be assessed. Co-registration of PET and MRI data sets to provide cellular and molecular information on plaque composition and stability is now possible. Furthermore, novel imaging modalities have been implemented to guide electrophysiological and transcatheter-based procedures, such as cardiac resynchronization therapy (an established treatment for patients with heart failure), and transcatheter valve repair or replacement procedures.
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De Craene M, Piella G, Camara O, Duchateau N, Silva E, Doltra A, D’hooge J, Brugada J, Sitges M, Frangi AF. Temporal diffeomorphic free-form deformation: Application to motion and strain estimation from 3D echocardiography. Med Image Anal 2012; 16:427-50. [PMID: 22137545 DOI: 10.1016/j.media.2011.10.006] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 10/25/2011] [Accepted: 10/25/2011] [Indexed: 11/27/2022]
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