1
|
Shangguan Q, Liu Q, Yang R, Zhang S, Sheng G, Kuang M, Zou Y. Predictive value of insulin resistance surrogates for the development of diabetes in individuals with baseline normoglycemia: findings from two independent cohort studies in China and Japan. Diabetol Metab Syndr 2024; 16:68. [PMID: 38491516 PMCID: PMC10943817 DOI: 10.1186/s13098-024-01307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) plays a crucial role in the occurrence and progression of diabetes. This study aimed to evaluate and compare the predictive value of four IR surrogates, including the triglycerides glucose (TyG) index, TyG and body mass index (TyG-BMI), triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio, and the metabolic score for IR (MetS-IR) for diabetes in two large cohorts. METHODS A total of 116,661 adult participants from the China Rich Healthcare Group and 15,464 adult participants from the Japanese NAGALA cohort were included in the study. Multivariable Cox proportional hazards models were used to assess the standardized hazard ratio (HR) of the TyG index, TyG-BMI, TG/HDL-C ratio, and MetS-IR directly associated with diabetes. Receiver operating characteristic (ROC) curve and time-dependent ROC curve analysis were performed to evaluate and compare the predictive value of the four IR surrogates for diabetes. RESULTS In the two independent cohorts, the average follow-up time was 3.1 years in the China cohort, with 2681(2.30%) incident cases of diabetes recorded, and 6.13 years in the Japan cohort, with 373 incident cases (2.41%) of diabetes recorded. After adjusting for potential confounding factors, we found that among the four IR surrogates, TyG-BMI and MetS-IR showed stronger associations with diabetes. The stronger associations persisted even after further stratification by age, sex, hypertension, and obese subgroups. In terms of diabetes prediction, based on ROC analysis, TyG-BMI demonstrated the highest predictive accuracy for diabetes in the Chinese population, while both TyG-BMI and MetS-IR showed the highest predictive accuracy in the Japanese population. The results of further subgroup ROC analysis confirmed the robustness of these findings. Furthermore, the time-dependent ROC results indicated that among the four IR surrogates, MetS-IR exhibited the highest accuracy in predicting future diabetes at various time intervals in the Japanese population. CONCLUSION Our findings suggest that evaluating TyG-BMI and MetS-IR as IR surrogates may be the most useful for predicting diabetes events and assessing the risk of developing diabetes in East Asian populations.
Collapse
Affiliation(s)
- Qing Shangguan
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Qiuling Liu
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Ruijuan Yang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Endocrinology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Shuhua Zhang
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Maobin Kuang
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
| | - Yang Zou
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
| |
Collapse
|
2
|
Dutta A, Alqabbani RRM, Hagendorff A, Tayal B. Understanding the Application of Mechanical Dyssynchrony in Patients with Heart Failure Considered for CRT. J Cardiovasc Dev Dis 2024; 11:64. [PMID: 38392278 PMCID: PMC10888548 DOI: 10.3390/jcdd11020064] [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: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Over the past two decades of CRT use, the failure rate has remained around 30-35%, despite several updates in the guidelines based on the understanding from multiple trials. This review article summarizes the role of mechanical dyssynchrony in the selection of heart failure patients for cardiac resynchronization therapy. Understanding the application of mechanical dyssynchrony has also evolved during these past two decades. There is no role of lone mechanical dyssynchrony in the patient selection for CRT. However, mechanical dyssynchrony can complement the electrocardiogram and clinical criteria and improve patient selection by reducing the failure rate. An oversimplified approach to mechanical dyssynchrony assessment, such as just estimating time-to-peak delays between segments, should not be used. Instead, methods that can identify the underlying pathophysiology of HF and are representative of a substrate to CRT should be applied.
Collapse
Affiliation(s)
- Abhishek Dutta
- Department of Cardiology, Nazareth Hospital, Philadelphia, PA 19020, USA
| | - Rakan Radwan M Alqabbani
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, 04103 Leipzig, Germany
| | - Bhupendar Tayal
- Harrington and Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| |
Collapse
|
3
|
Sisti N, Cardona A, Baldi E, Sciaccaluga C, Notaristefano F, Santoro A, Mandoli GE, Cameli M. Multimodality Imaging for Selecting Candidates for CRT: Do We Have a Single Alley to Increase Responders? Curr Probl Cardiol 2024; 49:102150. [PMID: 37863462 DOI: 10.1016/j.cpcardiol.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Cardiac resynchronization therapy has evolved in recent years to provide a reduction of morbidity and mortality for many patients with heart failure. Its application and optimization is an evolving field and its use requires a multidisciplinary approach for patient and device selection, technical preprocedural planning, and optimization. While echocardiography has always been considered the first line for the evaluation of patients, additional imaging techniques have gained increasing evidence in recent years. Today different details about heart anatomy, function, dissynchrony can be investigated by magnetic resonance, cardiac computed tomography, nuclear imaging, and more, with the aim of obtaining clues to reach a maximal response from the electrical therapy. The purpose of this review is to provide a practical analysis of the single and combined use of different imaging techniques in the preoperative and perioperative phases of cardiac resynchronization therapy, underlining their main advantages, limitations, and information provided.
Collapse
Affiliation(s)
- Nicolò Sisti
- Department of Cardiology, Hospital of Gubbio, Gubbio, Italy.
| | - Andrea Cardona
- Division of Advanced Cardiovascular Diagnostics, Regional Healthcare Unit, Todi Hospital, Todi, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | | | - Amato Santoro
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| |
Collapse
|
4
|
Stankovic I, Voigt JU, Burri H, Muraru D, Sade LE, Haugaa KH, Lumens J, Biffi M, Dacher JN, Marsan NA, Bakelants E, Manisty C, Dweck MR, Smiseth OA, Donal E. Imaging in patients with cardiovascular implantable electronic devices: part 1-imaging before and during device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J Cardiovasc Imaging 2023; 25:e1-e32. [PMID: 37861372 DOI: 10.1093/ehjci/jead272] [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: 10/14/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
More than 500 000 cardiovascular implantable electronic devices (CIEDs) are implanted in the European Society of Cardiology countries each year. The role of cardiovascular imaging in patients being considered for CIED is distinctly different from imaging in CIED recipients. In the former group, imaging can help identify specific or potentially reversible causes of heart block, the underlying tissue characteristics associated with malignant arrhythmias, and the mechanical consequences of conduction delays and can also aid challenging lead placements. On the other hand, cardiovascular imaging is required in CIED recipients for standard indications and to assess the response to device implantation, to diagnose immediate and delayed complications after implantation, and to guide device optimization. The present clinical consensus statement (Part 1) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients undergoing implantation of conventional pacemakers, cardioverter defibrillators, and resynchronization therapy devices. The document summarizes the existing evidence regarding the use of imaging in patient selection and during the implantation procedure and also underlines gaps in evidence in the field. The role of imaging after CIED implantation is discussed in the second document (Part 2).
Collapse
Affiliation(s)
- Ivan Stankovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Faculty of Medicine, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven/Department of Cardiovascular Sciences, Catholic University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- Department of Cardiology, University of Baskent, Ankara, Turkey
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine Karolinska Institutet AND Cardiovascular Division, Karolinska University Hospital, StockholmSweden
| | - Joost Lumens
- Cardiovascular Research Center Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, F 76000 Rouen, France
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Elise Bakelants
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| |
Collapse
|
5
|
Song Y, Chen X, Yang K, Dong Z, Cui C, Zhao K, Cheng H, Ji K, Lu M, Zhao S. Cardiac MRI-derived Myocardial Fibrosis and Ventricular Dyssynchrony Predict Response to Cardiac Resynchronization Therapy in Patients with Nonischemic Dilated Cardiomyopathy. Radiol Cardiothorac Imaging 2023; 5:e220127. [PMID: 37908550 PMCID: PMC10613947 DOI: 10.1148/ryct.220127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/05/2023] [Accepted: 08/22/2023] [Indexed: 11/02/2023]
Abstract
Purpose To determine the association of myocardial fibrosis and left ventricular (LV) dyssynchrony measured using cardiac MRI with late gadolinium enhancement (LGE) and feature tracking (FT), respectively, with response to cardiac resynchronization therapy (CRT) for nonischemic dilated cardiomyopathy (DCM). Materials and Methods This retrospective study included 98 patients (mean age, 59 years ± 10 [SD]; 54 men) who had nonischemic DCM, as assessed with LGE cardiac MRI before CRT. Cardiac MRI FT-derived dyssynchrony was defined as the SD of the time-to-peak strain (TTP-SD) of the LV segments in three directions (longitudinal, radial, and circumferential). CRT response was defined as a 15% increase in LV ejection fraction (LVEF) at echocardiography at 6-month follow-up, and then, long-term cardiovascular events were assessed. The likelihood ratio test was used to evaluate the incremental prognostic value of LGE and dyssynchrony parameters. Results Seventy-one (72%) patients showed a favorable LVEF response following CRT. LGE presence (odds ratio: 0.14 [95% CI: 0.04, 0.47], P = .002; and hazard ratio: 3.52 [95% CI: 1.37, 9.07], P = .01) and lower circumferential TTP-SD (odds ratio: 1.04 [95% CI: 1.02, 1.07], P = .002; and hazard ratio: 0.98 [95% CI: 0.96, 1.00], P = .03) were independently associated with LVEF nonresponse and long-term outcomes. Combined LGE and circumferential TTP-SD provided the highest discrimination for LVEF nonresponse (area under the receiver operating characteristic curve [AUC]: 0.89 [95% CI: 0.81, 0.94], sensitivity: 84.5% [95% CI: 74.0%, 92.0%], specificity: 85.2% [95% CI: 66.3%, 95.8%]) and long-term outcomes (AUC: 0.84 [95% CI: 0.75, 0.91], sensitivity: 76.9% [95% CI: 56.4%, 91.0%], specificity: 87.0% [95% CI: 76.7%, 93.9%]). Conclusion Myocardial fibrosis and lower circumferential dyssynchrony assessed with pretherapy cardiac MRI were independently associated with unfavorable LVEF response and long-term events following CRT in patients with nonischemic DCM and may provide incremental value in predicting prognosis.Keywords: MR Imaging, Cardiac, Outcomes Analysis Supplemental material is available for this article. © RSNA, 2023.
Collapse
Affiliation(s)
| | | | - Kai Yang
- From the Department of Magnetic Resonance Imaging (Y.S., X.C., K.Y.,
Z.D., C.C., K.J., M.L., S.Z.), Department of Function Test Center (H.C.), and
Department of Radiology Imaging Center (S.Z.), Fuwai Hospital, National Center
for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, 167
Beilishi Road, Xi Cheng District, Beijing 100037, China; and Paul C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced
Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
(K.Z.)
| | - Zhixiang Dong
- From the Department of Magnetic Resonance Imaging (Y.S., X.C., K.Y.,
Z.D., C.C., K.J., M.L., S.Z.), Department of Function Test Center (H.C.), and
Department of Radiology Imaging Center (S.Z.), Fuwai Hospital, National Center
for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, 167
Beilishi Road, Xi Cheng District, Beijing 100037, China; and Paul C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced
Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
(K.Z.)
| | - Chen Cui
- From the Department of Magnetic Resonance Imaging (Y.S., X.C., K.Y.,
Z.D., C.C., K.J., M.L., S.Z.), Department of Function Test Center (H.C.), and
Department of Radiology Imaging Center (S.Z.), Fuwai Hospital, National Center
for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, 167
Beilishi Road, Xi Cheng District, Beijing 100037, China; and Paul C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced
Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
(K.Z.)
| | - Kankan Zhao
- From the Department of Magnetic Resonance Imaging (Y.S., X.C., K.Y.,
Z.D., C.C., K.J., M.L., S.Z.), Department of Function Test Center (H.C.), and
Department of Radiology Imaging Center (S.Z.), Fuwai Hospital, National Center
for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, 167
Beilishi Road, Xi Cheng District, Beijing 100037, China; and Paul C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced
Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
(K.Z.)
| | - Huaibing Cheng
- From the Department of Magnetic Resonance Imaging (Y.S., X.C., K.Y.,
Z.D., C.C., K.J., M.L., S.Z.), Department of Function Test Center (H.C.), and
Department of Radiology Imaging Center (S.Z.), Fuwai Hospital, National Center
for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, 167
Beilishi Road, Xi Cheng District, Beijing 100037, China; and Paul C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced
Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
(K.Z.)
| | - Keshan Ji
- From the Department of Magnetic Resonance Imaging (Y.S., X.C., K.Y.,
Z.D., C.C., K.J., M.L., S.Z.), Department of Function Test Center (H.C.), and
Department of Radiology Imaging Center (S.Z.), Fuwai Hospital, National Center
for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, 167
Beilishi Road, Xi Cheng District, Beijing 100037, China; and Paul C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced
Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
(K.Z.)
| | - Minjie Lu
- From the Department of Magnetic Resonance Imaging (Y.S., X.C., K.Y.,
Z.D., C.C., K.J., M.L., S.Z.), Department of Function Test Center (H.C.), and
Department of Radiology Imaging Center (S.Z.), Fuwai Hospital, National Center
for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, 167
Beilishi Road, Xi Cheng District, Beijing 100037, China; and Paul C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced
Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
(K.Z.)
| | - Shihua Zhao
- From the Department of Magnetic Resonance Imaging (Y.S., X.C., K.Y.,
Z.D., C.C., K.J., M.L., S.Z.), Department of Function Test Center (H.C.), and
Department of Radiology Imaging Center (S.Z.), Fuwai Hospital, National Center
for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, 167
Beilishi Road, Xi Cheng District, Beijing 100037, China; and Paul C. Lauterbur
Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced
Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
(K.Z.)
| |
Collapse
|
6
|
Hopman LHGA, Zweerink A, van der Lingen ALCJ, Huntelaar MJ, Mulder MJ, Robbers LFHJ, van Rossum AC, van Halm VP, Götte MJW, Allaart CP. Feasibility of CMR Imaging during Biventricular Pacing: Comparison with Invasive Measurement as a Pathway towards a Novel Optimization Strategy. J Clin Med 2023; 12:3998. [PMID: 37373691 PMCID: PMC10298880 DOI: 10.3390/jcm12123998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This prospective pilot study assessed the feasibility of cardiovascular magnetic resonance (CMR) imaging during biventricular (BIV) pacing in patients with a CMR conditional cardiac resynchronization therapy defibrillator (CRT-D) and compared the results with invasive volume measurements. METHODS Ten CRT-D patients underwent CMR imaging prior to device implantation (baseline) and six weeks after device implantation, including CRT-on and CRT-off modes. Left ventricular (LV) function, volumes, and strain measurements of LV dyssynchrony and dyscoordination were assessed. Invasive pressure-volume measurements were performed, matching the CRT settings used during CMR. RESULTS Post-implantation imaging enabled reliable cine assessment, but showed artefacts on late gadolinium enhancement images. After six weeks of CRT, significant reverse remodeling was observed, with a 22.7 ± 11% reduction in LV end-systolic volume during intrinsic rhythm (CRT-off). During CRT-on, the LV ejection fraction significantly improved from 27.4 ± 5.9% to 32.2 ± 8.7% (p < 0.01), and the strain assessment showed the abolition of the left bundle branch block contraction pattern. Invasively measured and CMR-assessed LV hemodynamics during BIV pacing were significantly associated. CONCLUSIONS Post-CRT implantation CMR assessing acute LV pump function is feasible and provides important insights into the effects of BIV pacing on cardiac function and contraction patterns. LV assessment during CMR may constitute a future CRT optimization strategy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; (L.H.G.A.H.)
| |
Collapse
|
7
|
Kuang M, Yang R, Huang X, Wang C, Sheng G, Xie G, Zou Y. Assessing temporal differences in the predictive power of baseline TyG-related parameters for future diabetes: an analysis using time-dependent receiver operating characteristics. J Transl Med 2023; 21:299. [PMID: 37138277 PMCID: PMC10158224 DOI: 10.1186/s12967-023-04159-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND It is known that measuring the triglyceride glucose (TyG) index and TyG-related parameters [triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-waist to height ratio (TyG-WHtR)] can predict diabetes; this study aimed to compare the predictive value of the baseline TyG index and TyG-related parameters for the onset of diabetes at different future periods. METHODS We conducted a longitudinal cohort study involving 15,464 Japanese people who had undergone health physical examinations. The subject's TyG index and TyG-related parameters were measured at the first physical examination, and diabetes was defined according to the American Diabetes Association criteria. Multivariate Cox regression models and time-dependent receiver operating characteristic (ROC) curves were constructed to examine and compare the risk assessment/predictive value of the TyG index and TyG-related parameters for the onset of diabetes in different future periods. RESULTS The mean follow-up period of the current study cohort was 6.13 years, with a maximum of 13 years, and the incidence density of diabetes was 39.88/10,000 person-years. In multivariate Cox regression models with standardized hazard ratios (HRs), we found that both the TyG index and TyG-related parameters were significantly and positively associated with diabetes risk and that the TyG-related parameters were stronger in assessing diabetes risk than the TyG index, with TyG-WC being the best parameter (HR per SD increase: 1.70, 95% CI 1.46, 1.97). In addition, TyG-WC also showed the highest predictive accuracy in time-dependent ROC analysis for diabetes occurring in the short-term (2-6 years), while TyG-WHtR had the highest predictive accuracy and the most stable predictive threshold for predicting the onset of diabetes in the medium- to long-term (6-12 years). CONCLUSIONS These results suggest that the TyG index combined with BMI, WC, and WHtR can further improve its ability to assess/predict the risk of diabetes in different future periods, where TyG-WC was not only the best parameter for assessing diabetes risk but also the best risk marker for predicting future diabetes in the short-term, while TyG-WHtR may be more suitable for predicting future diabetes in the medium- to long-term.
Collapse
Affiliation(s)
- Maobin Kuang
- Medical College of Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Ruijuan Yang
- Medical College of Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Endocrinology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Xin Huang
- Medical College of Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Chao Wang
- Medical College of Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Guotai Sheng
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Guobo Xie
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
| |
Collapse
|
8
|
Zand S, Sadeghian H, Kazemisaied A, Ashraf H, Lotfi-Tokaldany M, Jalali A. Predicting factors of echocardiographic super-response to cardiac resynchronization therapy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:388-393. [PMID: 36367352 DOI: 10.1002/jcu.23380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To investigate the clinical and echocardiographic predictors of echocardiographic super-response to cardiac resynchronization therapy (CRT) in heart failure patients. METHODS We retrospectively collected data from 97 patients, who underwent CRT and were followed up (median time = 20.33 months). All had left ventricular ejection fraction (LVEF) ≤35%, New-York-Heart-Association class 3 or 4, and Q wave, R wave and S wave (QRS) duration >120 ms. Time-to-peak systolic velocity was measured for individual LV segments by tissue Doppler imaging prior to CRT. Two-dimensional echocardiography was carried out before and at follow-up, and ≥12.5% increase in LVEF was defined as super-response. RESULTS From the 97 patients, 23 (23.7%) were super-responders. Super-responders were more frequently female (52.2% vs. 24.3%, respectively; p value = 0.012). Among super-responders, the mean of LV end-diastolic and end-systolic volumes were significantly lower. According to dyssynchrony indices, time delay between anteroseptal and posterior wall and SD of all LV segments timing showed significantly higher values in super-responders. By multivariate analysis, LV end-systolic volume and anteroseptal-to-posterior wall delay remained independently associated with echocardiographic super-response to CRT. CONCLUSION About one-fourth of our patients with CRT were super-responder in that they had ≥12.5% increase in LVEF by echocardiography. Among all the clinical and echocardiographic measures, only lower LV end-systolic volume and higher anteroseptal-to-posterior wall delay predicted super-response.
Collapse
Affiliation(s)
- Sara Zand
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hakimeh Sadeghian
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kazemisaied
- Department of Electrophysiology, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Haleh Ashraf
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Lotfi-Tokaldany
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Vigdor A, Bravo PE. Mechanical Dyssynchrony with Gated Myocardial Perfusion SPECT: Reproducibility is the Key. J Nucl Cardiol 2022; 29:962-964. [PMID: 33389642 DOI: 10.1007/s12350-020-02463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron Vigdor
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
| |
Collapse
|
10
|
Allen LaPointe NM, Ali-Ahmed F, Dalgaard F, Kosinski AS, Schmidler GS, Al-Khatib SM. Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis. J Interv Cardiol 2022; 2022:6285894. [PMID: 35655661 PMCID: PMC9146808 DOI: 10.1155/2022/6285894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 12/07/2022] Open
Abstract
Aim To assess evidence for an image-guided approach for cardiac resynchronization therapy (CRT) that targets left ventricular (LV) lead placement at the segment of latest mechanical activation. Methods A systematic review of EMBASE and PubMed was performed for randomized controlled trials (RCTs) and prospective observational studies from October 2008 through October 2020 that compared an image-guided CRT approach with a non-image-guided approach for LV lead placement. Meta-analyses were performed to assess the association between the image-guided approach and NYHA class improvement or changes in end-systolic volume (LVESV), end-diastolic volume (LVEDV), and ejection fraction (LVEF). Results From 5897 citations, 5 RCTs including 818 patients (426 image-guided and 392 non-image-guided) were identified. The mean age ranged from 66 to 71 years, 76% were male, and 53% had ischemic cardiomyopathy. Speckle tracking echocardiography was the primary image-guided method in all studies. LV lead placement within the segment of the latest mechanical activation (concordant) was achieved in the image-guided arm in 45% of the evaluable patients. There was a statistically significant improvement in the NYHA class at 6 months (odds ratio 1.66; 95% confidence interval (CI) [1.02, 2.69]) with the image-guided approach, but no statistically significant change in LVESV (MD -7.1%; 95% CI [-16.0, 1.8]), LVEDV (MD -5.2%; 95% CI [-15.8, 5.4]), or LVEF (MD 0.68; 95% CI [-4.36, 5.73]) versus the non-image-guided approach. Conclusion The image-guided CRT approach was associated with improvement in the NYHA class but not echocardiographic measures, possibly due to the small sample size and a low rate of concordant LV lead placement despite using the image-guided approach. Therefore, our meta-analysis was not able to identify consistent improvement in CRT outcomes with an image-guided approach.
Collapse
Affiliation(s)
- Nancy M. Allen LaPointe
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC 27708, USA
| | | | - Frederik Dalgaard
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Andrzej S. Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Clinical Research Institute, Durham, NC 27710, USA
| | - Gillian Sanders Schmidler
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC 27708, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Sana M. Al-Khatib
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Clinical Research Institute, Durham, NC 27710, USA
- Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
| |
Collapse
|
11
|
Fixsen LS, Wouters PC, Lopata RGP, Kemps HMC. Strain-based discoordination imaging during exercise in heart failure with reduced ejection fraction: Feasibility and reproducibility. BMC Cardiovasc Disord 2022; 22:127. [PMID: 35337295 PMCID: PMC8957182 DOI: 10.1186/s12872-022-02578-w] [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: 07/19/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Various parameters of mechanical dyssynchrony have been proposed to improve patient selection criteria for cardiac resynchronization therapy, but sensitivity and specificity are lacking. However, echocardiographic parameters are consistently investigated at rest, whereas heart failure (HF) symptoms predominately manifest during submaximal exertion. Although strain-based predictors of response are promising, feasibility and reproducibility during exercise has yet to be demonstrated. METHODS Speckle-tracking echocardiography was performed in patients with HF at two separate visits. Echocardiography was performed at rest, during various exercise intensity levels, and during recovery from exercise. Systolic rebound stretch of the septum (SRSsept), systolic shortening, and septal discoordination index (SDI) were calculated. RESULTS Echocardiography was feasible in about 70-80% of all examinations performed during exercise. Of these acquired views, 84% of the cine-loops were suitable for analysis of strain-based mechanical dyssynchrony. Test-retest variability and intra- and inter-operator reproducibility at 30% and 60% of the ventilatory threshold (VT) were about 2.5%. SDI improved in the majority of patients at 30% and 60% of the VT, with moderate to good agreement between both intensity levels. CONCLUSION Although various challenges remain, exercise echocardiography with strain analysis appears to be feasible in the majority of patients with dyssynchronous heart failure. Inter- and intra-observer agreement of SRSsept and SDI up to 60% of the VT were comparable to resting values. During exercise, the extent of SDI was variable, suggesting a heterogeneous response to exercise. Further research is warranted to establish its clinical significance.
Collapse
Affiliation(s)
- Louis S Fixsen
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - Philippe C Wouters
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Richard G P Lopata
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
12
|
Lapidot D, Rav-Acha M, Bdolah-Abram T, Farkash R, Glikson M, Hasin T. QRS Narrowing Following CRT Implantation: Predictors, Dynamics, and Association with Improved Long-Term Outcome. J Clin Med 2022; 11:1279. [PMID: 35268370 PMCID: PMC8911497 DOI: 10.3390/jcm11051279] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Heart failure (HF) patients with wide QRS often benefit from cardiac resynchronization therapy (CRT), although QRS narrowing does not always occur. The current study investigates the incidence and predictors for QRS narrowing following CRT and its long-term impact on clinical outcomes. Methods: Among individuals undergoing clinically indicated CRT, pre-and post-implantation electrocardiographs were meticulously analyzed for QRS duration change. All-cause mortality and the composite of mortality and HF hospitalizations were retrieved. Results: For 104 patients, mean age 67 years, 25% females, QRS narrowed within days by 20.2 ± 24.7 ms. In 55/104 (53%) QRS narrowed by ≥20 ms (“acute narrowing”). Female gender and baseline QRS predicted acute narrowing. Acute narrowing persisted for 1−6 weeks in 18/20 (90%) and 3−12 months in 21/31 (68%) of patients. During the average follow-up of 41 months, 29/104 (28%) died and 50/104 (48%) met the composite outcome. In a multivariable analysis including comorbidities and cardiac history, prolonged baseline PR interval (HR 1.015, CI 1.008−1.021, p < 0.001) and acute narrowing < 20 ms (HR 3.243, CI 1.593−6.603, p = 0.001) were significant and independent predictors for the composite outcome. Conclusions: Post-CRT acute QRS narrowing ≥ 20 ms is independently associated with favorable long-term outcomes and might be considered as a novel measure for procedural success.
Collapse
Affiliation(s)
- Daniel Lapidot
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
| | - Moshe Rav-Acha
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center (SZMC), Jerusalem 9103102, Israel;
| | - Tali Bdolah-Abram
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
| | - Rivka Farkash
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center (SZMC), Jerusalem 9103102, Israel;
| | - Michael Glikson
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center (SZMC), Jerusalem 9103102, Israel;
| | - Tal Hasin
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center (SZMC), Jerusalem 9103102, Israel;
| |
Collapse
|
13
|
Tokavanich N, Prasitlumkum N, Mongkonsritragoon W, Trongtorsak A, Cheungpasitporn W, Chokesuwattanaskul R. QRS area as a predictor of cardiac resynchronization therapy response: a systematic review and meta-analysis. Pacing Clin Electrophysiol 2022; 45:393-400. [PMID: 35000207 DOI: 10.1111/pace.14441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/09/2021] [Accepted: 01/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND QRS area, a three-dimensional QRS complex, is a novel vectorcardiography method of measuring the magnitude of electrical forces in the heart. Hypothetically, a greater QRS area denotes higher dyssynchrony and indicates potential benefits from cardiac resynchronization therapy (CRT). Previous studies suggest a positive correlation between QRS area and the degree of response to CRT, but its clinical use remains unclear. We performed a meta-analysis of the relationship between QRS area and survival benefit following CRT. METHODS We comprehensively searched the MEDLINE, EMBASE, and Cochrane databases from inception to August 2021. We included studies with prospective and retrospective cohort designs that reported QRS area before CRT and total mortality. Data from each study were analyzed using a random-effects model. The results were reported as a hazard ratio (HR) and 95% confidence intervals. RESULTS Five observational studies including 4,931 patients were identified. The cut-off values between large and small QRS areas ranged from 102-116 μVs. Our analysis showed a larger QRS area was statistically associated with increased 5-year survival in patients implanted with CRT (HR pooled 0.48, 95% CI 0.46-0.51, I2 = 54%, P < 0.0001). Greater QRS area reduction (pre- and post-implantation) were associated with a lower total mortality rate (HR pooled 0.45, 95% CI 0.38-0.52, I2 = 0%, P < 0.0001). CONCLUSION Larger pre-implantation QRS area was associated with increased survival after CRT. QRS area reduction following CRT implantation was also associated with lower mortality. QRS area may potentially become an additional selection criterion for CRT implantations. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Nithi Tokavanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand.,Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, California, USA
| | - Wimwipa Mongkonsritragoon
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | | | | | - Ronpichai Chokesuwattanaskul
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand.,Department of Medicine, Amita Health St. Francis, Evanston, IL, 60202, USA.,Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
14
|
Assessment of left ventricular dyssynchrony by speckle tracking echocardiography in children with duchenne muscular dystrophy. Int J Cardiovasc Imaging 2021; 38:79-89. [PMID: 34905152 DOI: 10.1007/s10554-021-02369-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/27/2021] [Indexed: 10/19/2022]
Abstract
Prognosis of Duchenne muscular dystrophy (DMD) is related to cardiac dysfunction. Two dimensional-speckle tracking echocardiography (2D-STE) has recently emerged as a non-invasive functional biomarker for early detection of DMD-related cardiomyopathy. This study aimed to determine, in DMD children, the existence of left ventricle (LV) dyssynchrony using 2D-STE analysis. This prospective controlled study enrolled 25 boys with DMD (mean age 11.0 ± 3.5 years) with normal LV ejection fraction and 50 age-matched controls. Three measures were performed to assess LV mechanical dyssynchrony: the opposing-wall delays (longitudinal and radial analyses), the modified Yu index, and the time-to-peak delays of each segment. Feasibility and reproducibility of 2D-STE dyssynchrony were evaluated. All three mechanical dyssynchrony criteria were significantly higher in the DMD group than in healthy subjects: (1) opposing-wall delays in basal inferoseptal to basal anterolateral segments (61.4 ± 45.3 ms vs. 18.3 ± 50.4 ms, P < 0.001, respectively) and in mid inferoseptal to mid anterolateral segments (58.6 ± 35.3 ms vs. 42.4 ± 36.4 ms, P < 0.05, respectively), (2) modified Yu index (33.3 ± 10.1 ms vs. 28.5 ± 8.1 ms, P < 0.05, respectively), and (3) most of time-to-peak values, especially in basal and mid anterolateral segments. Feasibility was excellent and reliability was moderate to excellent, with ICC values ranging from 0.49 to 0.97. Detection of LV mechanical dyssynchrony using 2D-STE analysis is an easily and reproducible method in paediatric DMD. The existence of an early LV mechanical dyssynchrony visualized using 2D-STE analysis in children with DMD before the onset of cardiomyopathy represents a perspective for future paediatric drug trials in the DMD-related cardiomyopathy prevention.Clinical Trial Registration Clinicaltrials.gov NCT02418338. Post-hoc study, registered on April 16, 2015.
Collapse
|
15
|
Gallard A, Galli E, Hubert A, Bidaut A, Le Rolle V, Smiseth O, Voigt JU, Donal E, Hernández AI. Echocardiographic view and feature selection for the estimation of the response to CRT. PLoS One 2021; 16:e0252857. [PMID: 34111154 PMCID: PMC8191962 DOI: 10.1371/journal.pone.0252857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an implant-based therapy applied to patients with a specific heart failure (HF) profile. The identification of patients that may benefit from CRT is a challenging task and the application of current guidelines still induce a non-responder rate of about 30%. Several studies have shown that the assessment of left ventricular (LV) mechanics by speckle tracking echocardiography can provide useful information for CRT patient selection. A comprehensive evaluation of LV mechanics is normally performed using three different echocardioraphic views: 4, 3 or 2-chamber views. The aim of this study is to estimate the relative importance of strain-based features extracted from these three views, for the estimation of CRT response. Several features were extracted from the longitudinal strain curves of 130 patients and different methods of feature selection (out-of-bag random forest, wrapping and filtering) have been applied. Results show that more than 50% of the 20 most important features are calculated from the 4-chamber view. Although features from the 2- and 3-chamber views are less represented in the most important features, some of the former have been identified to provide complementary information. A thorough analysis and interpretation of the most informative features is also provided, as a first step towards the construction of a machine-learning chain for an improved selection of CRT candidates.
Collapse
Affiliation(s)
- Alban Gallard
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Arnaud Hubert
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Auriane Bidaut
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Virginie Le Rolle
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Otto Smiseth
- Center for Cardiological Innovation and Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
- * E-mail:
| | | |
Collapse
|
16
|
Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application. Diagnostics (Basel) 2021; 11:diagnostics11050892. [PMID: 34067703 PMCID: PMC8156791 DOI: 10.3390/diagnostics11050892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. However, its symptoms and signs are not specific or can be absent. In this context, transthoracic echocardiography plays a key role in diagnosing the various forms of HF, guiding therapeutic decision making and monitoring response to therapy. Over the last few decades, new ultrasound modalities have been introduced in the field of echocardiography, aiming at better understanding the morpho-functional abnormalities occurring in cardiovascular diseases. However, they are still struggling to enter daily and routine use. In our review article, we turn the spotlight on some of the newest ultrasound technologies; in particular, analysis of myocardial deformation by speckle tracking echocardiography, and intracardiac flow dynamics by color Doppler flow mapping, highlighting their promising applications to HF diagnosis and management. We also focus on the importance of these imaging modalities in the selection of responses to cardiac resynchronization therapy.
Collapse
|
17
|
Left bundle branch block without a typical contraction pattern is associated with increased risk of ventricular arrhythmias in cardiac resynchronization therapy patients. Int J Cardiovasc Imaging 2021; 37:1843-1851. [PMID: 33755881 DOI: 10.1007/s10554-021-02157-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/03/2021] [Indexed: 11/27/2022]
Abstract
Cardiac resynchronization therapy (CRT) reduces the risk of ventricular arrhythmias (VA) in heart failure (HF) patients with left bundle branch block (LBBB) while the effect is less clear among non-LBBB patients. This study aimed to investigate if absence of LBBB features whether by echocardiography or strict ECG criteria would identify patients at risk of developing VA in a cohort with LBBB according to conventional ECG criteria. Two hundred six CRT candidates were prospectively included from 2 centers. Prior to CRT presence of a typical LBBB contraction pattern was identified using longitudinal strain in the apical 4-chamber view. All preimplantation ECGs were categorized as LBBB or non-LBBB according to Strauss´ strict criteria. Primary end-point was defined as any appropriate antitachycardia pacing (ATP) or shock therapy within 2 years after CRT implantation. A total of 129 (63%) patients had a typical LBBB contraction pattern, while 134 (66%) met the strict ECG criteria. Over 2 years, 45 patients (22%) experienced VA. Absence of a typical LBBB contraction pattern was independently associated with an increased risk of VA (hazard ratio ([HR] 1.89; 95% CI 1.04 to 3.44; p: 0.036). Strict LBBB was not independently associated with the occurrence of VA. Fulfilling neither strict ECG nor echocardiographic criteria for LBBB was associated with a 3.3-fold increase in risk of VA ([HR] 3.34; 95% CI 1.75 to 6.94; (p < 0.001). The risk of VA was almost 2-fold higher if a typical LBBB contraction pattern was absent prior to CRT.
Collapse
|
18
|
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: 11] [Impact Index Per Article: 2.8] [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.
Collapse
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
| |
Collapse
|
19
|
von Jeinsen B, Short MI, Larson MG, Xanthakis V, McManus DD, Benjamin EJ, Mitchell GF, Aragam J, Cheng S, Vasan RS. Prognostic Significance of Echocardiographic Measures of Cardiac Remodeling. J Am Soc Echocardiogr 2020; 33:72-81.e6. [PMID: 31624026 PMCID: PMC6986561 DOI: 10.1016/j.echo.2019.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND In recent decades, novel echocardiographic measures have constantly emerged. It is still unclear which echocardiographic measures have the most significant prognostic value in the general population. Accordingly, the aim of this study was to compare the prognostic value of a large panel of echocardiographic measures to identify the most promising measures. METHODS A total of 1,497 Framingham study participants (mean age, 65 years; 55.4% women) who underwent echocardiographic measurements of left ventricular ejection fraction, left ventricular mass index, global longitudinal strain, global circumferential strain, mitral annular plane systolic excursion, mitral E/e' ratio, maximum and minimum left atrial (LA) volume index, LA emptying fraction, and left ventricular longitudinal synchrony were evaluated. These measures were related to the incidence of two composite outcomes: cardiovascular disease (CVD) or death and atrial fibrillation (AF) or congestive heart failure (CHF). RESULTS On follow-up (mean, 8.3 years), there were 241 CVD events or deaths and 139 AF or CHF events. In multivariate-adjusted Cox models, higher LA emptying fraction was associated with a lower risk (hazard ratios per SD, 0.80 and 0.70 for CVD or death and AF or CHF, respectively; P ≤ .001 for both) while higher minimum LA volume index (hazard ratios per SD, 1.32 and 1.70 for CVD or death and AF or CHF, respectively; P ≤ .001 for both) and maximum LA volume index (hazard ratios per SD, 1.26 and 1.54 for CVD or death and AF or CHF, respectively; P ≤ .002 for both) were associated with a higher risk for both composite outcomes. CONCLUSIONS In this community-based sample, LA volumes and function were the best echocardiographic predictors of clinical outcomes. Therefore, these values should be considered for inclusion in standard echocardiographic assessments for the purpose of risk stratification.
Collapse
Affiliation(s)
- Beatrice von Jeinsen
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Meghan I Short
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Martin G Larson
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Vanessa Xanthakis
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Emelia J Benjamin
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Jayashri Aragam
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Veterans Administration Hospital, West Roxbury, Massachusetts
| | - Susan Cheng
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| |
Collapse
|
20
|
Gorcsan J, Lumens J. Opposing Wall Pushing and Stretching. JACC Cardiovasc Imaging 2019; 12:2414-2416. [DOI: 10.1016/j.jcmg.2019.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
|
21
|
Index of contractile asymmetry improves patient selection for CRT: a proof-of-concept study. Cardiovasc Ultrasound 2019; 17:19. [PMID: 31601248 PMCID: PMC6788085 DOI: 10.1186/s12947-019-0170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 09/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nearly one-third of heart failure (HF) patients do not respond to cardiac resynchronization therapy (CRT) despite having left bundle branch block (LBBB). The aim of the study was to investigate a novel method of quantifying left ventricular (LV) contractile asymmetry in HF. METHODS Patients with HF and LBBB undergoing CRT (n = 89, 37.1% females, 68 ± 9 years, ischemic etiology in 61%, LV ejection fraction 27.1 ± 7.1%) were analyzed. LV longitudinal systolic strain rate values were extracted from curved anatomical M-mode plots of standard long-axis 2D-echocardiography images and cubic spline interpolation was used to generate a 3D-phantom. Index of contractile asymmetry (ICA) was calculated based on standard deviation of differences in strain rate of opposing walls. Average ICA was individually assessed pairwise in 12 opposing 30-degree LV sectors. Reduction in LV end-systolic volume (ESV) ≥15% after 6 months was considered as positive response to CRT. RESULTS CRT response was found in 66 (74.2%) patients. Responders with both ischemic and non-ischemic cardiomyopathy had a higher and more extensive contractile asymmetry at baseline and achieved a greater ICA reduction after CRT than non-responders. Higher baseline ICA predicted higher degree and wider extent of ICA improvement. Also, both ICA at baseline and reduction of ICA correlated with the degree of ESV reduction after CRT. CONCLUSIONS Quantification of asymmetrical LV activation in 3D by ICA provides valuable insights into LV contraction in case of LBBB and is a promising tool for improved patient selection for CRT.
Collapse
|
22
|
Interventricular dyssynchrony during continuous-flow left ventricular assist device support: observation using the conductance method. J Artif Organs 2019; 22:348-352. [DOI: 10.1007/s10047-019-01115-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 06/28/2019] [Indexed: 11/26/2022]
|
23
|
Galli E, Hubert A, Le Rolle V, Hernandez A, Smiseth OA, Mabo P, Leclercq C, Donal E. Myocardial constructive work and cardiac mortality in resynchronization therapy candidates. Am Heart J 2019; 212:53-63. [PMID: 30951976 DOI: 10.1016/j.ahj.2019.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent studies have shown that myocardial constructive work (CW) assessed by pressure-strain loops (PSLs) is an independent predictor of a volumetric response to cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the role of CW in predicting the cardiac outcome of heart failure patients undergoing CRT. METHODS This is a retrospective study including 166 CRT candidates (ejection fraction [EF] ≤35%, QRS duration ≥120 milliseconds). Two-dimensional standard echocardiography and speckle-tracking echocardiography were performed before CRT and at 6-month follow-up. PSLs were used to assess myocardial CW. RESULTS After a median follow-up of 4 years (range 1.3-5 years), cardiac death occurred in 14 patients (8%). A multivariable Cox regression analysis including age, coronary artery disease, and septal flash showed that CW≤888 mm Hg% was the only independent predictor of cardiac mortality (hazard ratio 4.23, 95% CI 1.08-16.5, P = .03). After 6 months of CRT, a 15% reduction in left ventricular end-systolic volume was observed in 118 (71%) patients, and a CRT volumetric response was identified. Among CRT responders, the concomitant presence of CW ≤888 mm Hg% identified a subgroup of patients at high risk of cardiac death (P = .04 in the log-rank test). The addition of CW ≤888 mm Hg% to a model including age, coronary artery disease, septal flash, and CRT response caused a significant increase in model power for the prediction of cardiac death (χ2: 12.6 vs 25.7, P = .02). CONCLUSIONS The estimation of left ventricular CW by PSLs is a relatively novel tool that allows for the prediction of cardiac outcome in CRT candidates.
Collapse
Affiliation(s)
- Elena Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France.
| | - Arnaud Hubert
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France
| | - Virginie Le Rolle
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France
| | - Alfredo Hernandez
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France
| | - Otto A Smiseth
- Oslo University Hospital, Department of Cardiology, Norway
| | - Philippe Mabo
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France
| | | | - Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France
| |
Collapse
|
24
|
Tahri JB, Hansen TF, Storkås HS, Lauridsen TK, Olsen FJ, Iversen A, Lindhardt TB, Bruun NE, Søgaard P, Risum N. Interlead electrical delays and scar tissue: Response to cardiac resynchronization therapy in patients with ischemic cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:530-536. [DOI: 10.1111/pace.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/31/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - Allan Iversen
- Department of CardiologyGentofte University Hospital Copenhagen Denmark
| | - Tommi Bo Lindhardt
- Department of CardiologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Herlev and Gentofte HospitalUniversity of Copenhagen Copenhagen Denmark
- Clinical InstituteAalborg University Aalborg Denmark
| | - Peter Søgaard
- Department of CardiologyAalborg University Hospital Aalborg Denmark
| | - Niels Risum
- Department of CardiologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
| |
Collapse
|
25
|
Abstract
Cardiac resynchronization therapy (CRT) is an electrical therapy to resolve an electrical problem. Any method to predict CRT response must specifically reflect the electrical substrate. Time-to-peak dyssynchrony is too unspecific for prediction of response because dyssynchrony by this approach may reflect the presence of scar or fibrosis even in the absence of conduction delay. New methods are based on the actual physiology of activation delay-induced heart failure (HF) and are superior to time-to-peak methods in predicting CRT response. Time-to-peak dyssynchrony may be used for prognosis in HF patients without signs of delayed ventricular activation and for monitoring CRT response.
Collapse
Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark.
| | - Niels Risum
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
| |
Collapse
|
26
|
Beela AS, Duchenne J, Petrescu A, Ünlü S, Penicka M, Aakhus S, Winter S, Aarones M, Stefanidis E, Fehske W, Willems R, Szulik M, Kukulski T, Faber L, Ciarka A, Neskovic AN, Stankovic I, Voigt JU. Sex-specific difference in outcome after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2019; 20:504-511. [DOI: 10.1093/ehjci/jey231] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/22/2018] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ahmed S Beela
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, km 4.5 Ring road, Ismailia, Egypt
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Aniela Petrescu
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Martin Penicka
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Svend Aakhus
- Department of Circulation and Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Stefan Winter
- Department of Internal Medicine and Cardiology, Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Marit Aarones
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Evangelos Stefanidis
- Department of Circulation and Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Wolfgang Fehske
- Department of Internal Medicine and Cardiology, Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Zabrze, Poland
| | - Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Zabrze, Poland
| | - Lothar Faber
- Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Aleksandar N Neskovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia
| | - Ivan Stankovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| |
Collapse
|
27
|
Menezes Junior ADS, Lopes CC, Cavalcante PF, Martins E. Chronic Chagas Cardiomyopathy Patients and Resynchronization Therapy: a Survival Analysis. Braz J Cardiovasc Surg 2018; 33:82-88. [PMID: 29617506 PMCID: PMC5873775 DOI: 10.21470/1678-9741-2017-0134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/09/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chagas disease represents an important health problem with socioeconomic impacts in many Latin-American countries. It is estimated that 20% to 30% of the people infected by Trypanosoma cruzi will develop chronic Chagas cardiomyopathy (CCC), which is generally accompanied by heart failure (HF). Cardiac resynchronization therapy (CRT) may be indicated for patients with HF and electromechanical dysfunctions. OBJECTIVE The primary endpoint of this study was to analyze the response to CRT in patients with CCC, while the secondary endpoint was to estimate the survival rates of CRT responder patients. METHODS This is an observational, cross-sectional and retrospective study. The records of 50 patients with CRT pacing devices implanted between June 2009 and March 2017 were analyzed. For statistical analyses, Pearson's correlation was used along with Student's t-test, and survival was analyzed using the Kaplan-Meier method. A P value of <0.05 was considered significant. RESULTS Out of 50 patients, 56% were male, with a mean age of 63.4±13.3 years and an average CRT duration of 61.2±21.7 months. The mean QRS duration was 150.12±12.4 ms before and 116.04±2.2 ms after the therapy (P<0.001). The mean left ventricular ejection fractions (LVEF) were 29±7% and 39.1±12.2% before and after CRT, respectively (P<0.001). A total of 35 (70%) patients had a reduction of at least one New York Heart Association (NYHA) functional class after six months of therapy (P=0.014). The survival rate after 72 months was 45%. CONCLUSION This study showed clinical improvement and a nonsignificant survival rate in patients with CCC after the use of CRT.
Collapse
Affiliation(s)
- Antônio da Silva Menezes Junior
- Escola de Ciências Médicas, Farmacêuticas e Biomédicas of the Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
| | - Cynthia Caetano Lopes
- Escola de Ciências Médicas, Farmacêuticas e Biomédicas of the Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
| | - Patrícia Freire Cavalcante
- Escola de Ciências Médicas, Farmacêuticas e Biomédicas of the Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
| | - Edésio Martins
- Escola de Ciências Médicas, Farmacêuticas e Biomédicas of the Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
| |
Collapse
|
28
|
Huntjens PR, Ploux S, Strik M, Walmsley J, Ritter P, Haissaguerre M, Prinzen FW, Delhaas T, Lumens J, Bordachar P. Electrical Substrates Driving Response to Cardiac Resynchronization Therapy. Circ Arrhythm Electrophysiol 2018; 11:e005647. [DOI: 10.1161/circep.117.005647] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Peter R. Huntjens
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Sylvain Ploux
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Marc Strik
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - John Walmsley
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Philippe Ritter
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Michel Haissaguerre
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Frits W. Prinzen
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Tammo Delhaas
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Joost Lumens
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Pierre Bordachar
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| |
Collapse
|
29
|
Lee R, Shah RV, Murthy VL. Assessment of dyssynchrony by gated myocardial perfusion imaging does not improve patient management. J Nucl Cardiol 2018; 25:526-531. [PMID: 28791621 PMCID: PMC6312556 DOI: 10.1007/s12350-017-1022-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 01/14/2023]
Abstract
Clinical trials have demonstrated improved outcomes with cardiac resynchronization therapy in patients with heart failure and electrical evidence of dyssynchrony. There has been intense effort at developing imaging markers of dyssynchrony with the aim of improved risk stratification. However, these efforts have not been fruitful to date. This article discusses mechanisms of cardiac dyssynchrony, reviews clinical data supporting resynchronization therapy, and addresses the lack of convincing evidence to support the use of noninvasive imaging measures of dyssynchrony in improving patient management.
Collapse
Affiliation(s)
- Ran Lee
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA.
| | - Ravi V Shah
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA
| |
Collapse
|
30
|
Kumar V. Dyssynchrony: a risk marker for ventricular arrhythmias? J Nucl Cardiol 2018; 25:570-571. [PMID: 29110289 DOI: 10.1007/s12350-017-1103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Vineet Kumar
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, 930 Faculty Office Towers, 510 20th Street South, Birmingham, AL, 35294-0006, USA.
| |
Collapse
|
31
|
Tayal B, Gorcsan J, Bax JJ, Risum N, Olsen NT, Singh JP, Abraham WT, Borer JS, Dickstein K, Gras D, Krum H, Brugada J, Robertson M, Ford I, Holzmeister J, Ruschitzka F, Sogaard P. Cardiac Resynchronization Therapy in Patients With Heart Failure and Narrow QRS Complexes. J Am Coll Cardiol 2018; 71:1325-1333. [DOI: 10.1016/j.jacc.2018.01.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
|
32
|
Beela AS, Ünlü S, Duchenne J, Ciarka A, Daraban AM, Kotrc M, Aarones M, Szulik M, Winter S, Penicka M, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Faber L, Stankovic I, Voigt JU. Assessment of mechanical dyssynchrony can improve the prognostic value of guideline-based patient selection for cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2018; 20:66-74. [DOI: 10.1093/ehjci/jey029] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ahmed S Beela
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, km 4.5 Ring road, Ismailia, Egypt
| | - Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Ana Maria Daraban
- Department of Internal Medicine and Gastroenterology, Clinical Emergency Hospital, University of Medicine and Pharmacy ‘Carol Davila’, Bucharest, Romania
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marit Aarones
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland
| | - Stefan Winter
- Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | | | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland
| | - Svend Aakhus
- Department of Circulation and Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology and Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Wolfgang Fehske
- Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Lothar Faber
- Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Ivan Stankovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
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
|
35
|
Vancheri F, Vancheri S, Henein M. Relationship between QRS measurements and left ventricular morphology and function in asymptomatic individuals. Echocardiography 2017; 35:301-307. [PMID: 29280530 DOI: 10.1111/echo.13782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIM QRS amplitude and duration are associated with increased left ventricular (LV) volume, mass and dysfunction. However, the diagnostic concordance between QRS measurements and LV morphology and function, as shown by Doppler echocardiography, is not well established. We investigated the relationships of QRS duration and amplitude with echocardiographic measurements of LV morphology and systolic and diastolic function in normal individuals. METHODS Individuals without signs or symptoms of coronary artery disease or heart failure, who underwent clinical examination as a part of a cross-sectional survey for the prevalence of coronary risk factors, randomly selected from the population list in Caltanissetta, Italy, were included in the study. QRS duration and amplitude were automatically measured using inbuilt software. LV ejection and filling patterns were studied using Doppler echocardiography. RESULTS We studied 184 individuals (96 men and 88 women), mean age 55.9 (11.3). QRS duration increased by 5.4 ms for every 100 g increase in LV mass, and by 4.6 ms for each 10 mm increase in LV end-diastolic diameter. The amplitude increased by 0.8 mm for every 100 g increase in LV mass. There was no relationship with LV dimensions. A nonlinear correlation was found between QRS amplitude and indexes of global dyssynchrony. The time-voltage QRS area correlated with LV mass, dimensions and indexes of dyssynchrony. There was no relationship between QRS measurements and ejection fraction. CONCLUSIONS QRS prolongation and increase in amplitude are strongly influenced by LV increased mass and volume, as well as by dyssynchrony, independently of ejection fraction.
Collapse
Affiliation(s)
| | | | - Michael Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Molecular and Clinical Sciences Research Institute, St George University, London, UK
| |
Collapse
|
36
|
Belkin MN, Upadhyay GA. Does Cardiac Resynchronization Therapy Benefit Patients with Non-Left Bundle Branch Block Prolonged QRS Patterns? Curr Cardiol Rep 2017; 19:125. [DOI: 10.1007/s11886-017-0929-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
37
|
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
|
38
|
Qiu Q, Yang L, Mai JT, Yang Y, Xie Y, Chen YX, Wang JF. Acute Effects of Multisite Biventricular Pacing on Dyssynchrony and Hemodynamics in Canines With Heart Failure. J Card Fail 2017; 23:304-311. [DOI: 10.1016/j.cardfail.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 12/13/2016] [Accepted: 01/09/2017] [Indexed: 01/14/2023]
|
39
|
Abstract
Objective: Cardiac resynchronization therapy (CRT) has been shown to induce a structural and electrical remodeling; the data on whether left ventricle (LV) reverse remodeling is associated with restitution of intrinsic contraction pattern are unknown. In this study, we investigated the presence of improvement in left ventricular intrinsic dyssynchrony in patients with CRT. Methods: A total of 45 CRT recipients were prospectively studied. Dyssynchrony indexes including interventricular mechanical delay (IVMD) and tissue Doppler velocity opposing-wall delay (OWD) as well as QRS duration on 12-lead surface electrocardiogram were recorded before CRT device implantation. After 1 year, patients with chronic biventricular pacing were reprogramed to VVI 40 to allow the resumption of native conduction and contraction pattern. After 4–6 h of intrinsic rhythm, QRS duration and all echocardiographic measurements were recorded. Dyssynchrony was defined as IVMD >40 ms and OWD >65 ms. CRT response was defined by a ≥15% reduction in left ventricular end-systolic volume (LVESV) at a 12-month follow-up. Results: Thirty-two patients (71%) showed response to CRT. The native QRS duration reduced significantly from 150±12 ms to 138±14 ms (p<0.001), and dyssynchrony indexes showed a significant improvement only in responders. The mean OWD reduced from 86±37 ms to 50±29 ms (p<0.001), and the mean IVMD decreased from 55±22 ms to 28±22 ms (p<0.001) in responders. The reduction in LVESV was significantly correlated with ΔOWD (r=0.47, p=0.001), ΔIVMD (r=0.45, p=0.001), and ΔQRS (r=0.34, p=0.022). Conclusion: Chronic CRT significantly improves LV native contraction pattern and causes reverse remodeling in dyssynchrony.
Collapse
|
40
|
Gage RM, Curtin AE, Burns KV, Ghosh S, Gillberg JM, Bank AJ. Changes in electrical dyssynchrony by body surface mapping predict left ventricular remodeling in patients with cardiac resynchronization therapy. Heart Rhythm 2017; 14:392-399. [DOI: 10.1016/j.hrthm.2016.11.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 10/20/2022]
|
41
|
Tayal B, Sogaard P, Delgado-Montero A, Goda A, Saba S, Risum N, Gorcsan J. Interaction of Left Ventricular Remodeling and Regional Dyssynchrony on Long-Term Prognosis after Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2017; 30:244-250. [DOI: 10.1016/j.echo.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 10/20/2022]
|
42
|
Risum N, Tayal B, Hansen TF, Bruun NE, Jensen MT, Lauridsen TK, Saba S, Kisslo J, Gorcsan J, Sogaard P. Identification of Typical Left Bundle Branch Block Contraction by Strain Echocardiography Is Additive to Electrocardiography in Prediction of Long-Term Outcome After Cardiac Resynchronization Therapy. J Am Coll Cardiol 2016; 66:631-41. [PMID: 26248989 DOI: 10.1016/j.jacc.2015.06.020] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/07/2015] [Accepted: 06/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current guidelines suggest that patients with left bundle branch block (LBBB) be treated with cardiac resynchronization therapy (CRT); however, one-third do not have a significant activation delay, which can result in nonresponse. By identifying characteristic opposing wall contraction, 2-dimensional strain echocardiography (2DSE) may detect true LBBB activation. OBJECTIVES This study sought to investigate whether the absence of a typical LBBB mechanical activation pattern by 2DSE was associated with unfavorable long-term outcome and if this is additive to electrocardiographic (ECG) morphology and duration. METHODS From 2 centers, 208 CRT candidates (New York Heart Association classes II to IV, ejection fraction ≤35%, QRS duration ≥120 ms) with LBBB by ECG were prospectively included. Before CRT implantation, longitudinal strain in the apical 4-chamber view determined whether typical LBBB contraction was present. The pre-defined outcome was freedom from death, left ventricular assist device, or heart transplantation over 4 years. RESULTS Two-thirds of patients (63%) had a typical LBBB contraction pattern. During 4 years, 48 patients (23%) reached the primary endpoint. Absence of a typical LBBB contraction was independently associated with increased risk of adverse outcome after adjustment for ischemic heart disease and QRS width (hazard ratio [HR]: 3.1; 95% CI: 1.64 to 5.88; p < 0.005). Adding pattern assessment to a risk prediction model including QRS duration and ischemic heart disease significantly improved the net reclassification index to 0.14 (p = 0.04) and improved the C-statistics (0.63 [95% CI: 0.54 to 0.72] vs. 0.71 [95% CI: 0.63 to 0.80]; p = 0.02). Use of strict LBBB ECG criteria was not independently associated with outcome in the multivariate model (HR: 1.72; 95% CI: 0.89 to 3.33; p = 0.11. Assessment of LBBB contraction pattern was superior to time-to-peak indexes of dyssynchrony (p < 0.01 for all). CONCLUSIONS Contraction pattern assessment to identify true LBBB activation provided important prognostic information in CRT candidates.
Collapse
Affiliation(s)
- Niels Risum
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
| | - Bhupendar Tayal
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas F Hansen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Niels E Bruun
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | | | - Trine K Lauridsen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Samir Saba
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph Kisslo
- Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina
| | - John Gorcsan
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter Sogaard
- Department of Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
43
|
Abstract
Echocardiographic imaging plays a major role in patient selection for cardiac resynchronization therapy (CRT). One-third of patients do not respond; there is interest in advanced echocardiographic imaging to improve response. Current guidelines favor CRT for patients with electrocardiographic (ECG) QRS width of 150 milliseconds or greater and left bundle branch block. ECG criteria are imperfect; there is interest in advanced echocardiographic imaging to improve patient selection. This discussion focuses on newer echocardiographic methods to improve patient selection, improve delivery, and identify patients at risk for poor outcomes and serious ventricular arrhythmias.
Collapse
Affiliation(s)
- John Gorcsan
- Heart and Vascular Institute, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Bhupendar Tayal
- Heart and Vascular Institute, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
44
|
Carità P, Corrado E, Pontone G, Curnis A, Bontempi L, Novo G, Guglielmo M, Ciaramitaro G, Assennato P, Novo S, Coppola G. Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocardiography. A brief review. Int J Cardiol 2016; 225:402-407. [PMID: 27776243 DOI: 10.1016/j.ijcard.2016.09.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is a successful strategy for heart failure (HF) patients. The pre-requisite for the response is the evidence of electrical dyssynchrony on the surface electrocardiogram usually as left bundle branch block (LBBB). Non-response to CRT is a significant problem in clinical practice. Patient selection, inadequate delivery and sub-optimal left ventricle lead position may be important causes. OBJECTIVES In an effort to improve CRT response multimodality imaging (especially echocardiography, computed tomography and cardiac magnetic resonance) could play a decisive role and extensive literature has been published on the matter. However, we are so far from routinary use in clinical practice. Electrocardiography (with respect to left ventricle capture and QRS narrowing) may represent a simple and low cost approach for early prediction of potential non-responder, with immediate practical implications. CONCLUSION This brief review covers the current recommendations for CRT in HF patients with particular attention to the potential benefits of multimodality imaging and electrocardiography in improving response rate.
Collapse
Affiliation(s)
- Patrizia Carità
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
| | - Egle Corrado
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | | | - Antonio Curnis
- Chair and Unit of Cardiology University of Brescia, Spedali Civili Hospital, Italy
| | - Luca Bontempi
- Chair and Unit of Cardiology University of Brescia, Spedali Civili Hospital, Italy
| | - Giuseppina Novo
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | | | | | - Pasquale Assennato
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Salvatore Novo
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Giuseppe Coppola
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| |
Collapse
|
45
|
Marek J, Gandalovičová J, Kejřová E, Pšenička M, Linhart A, Paleček T. Echocardiography and cardiac resynchronization therapy. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
46
|
Abstract
Deformation imaging by echocardiography is a well-established research tool which has been gaining interest from clinical cardiologists since the introduction of speckle tracking. Post-processing of echo images to analyze deformation has become readily available at the fingertips of the user. New parameters such as global longitudinal strain have been shown to provide added diagnostic value, and ongoing efforts of the imaging societies and industry aimed at harmonizing methods will improve the technique further. This review focuses on recent advances in the field of echocardiographic strain and strain rate imaging, and provides an overview on its current and potential future clinical applications.
Collapse
Affiliation(s)
- Oana Mirea
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat, Leuven, Belgium
| | - Jurgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat, Leuven, Belgium; Department of Cardiovascular Diseases, UZ Leuven - University Hospitals Leuven, Herestraat, Leuven, Belgium
| |
Collapse
|
47
|
Khan SG, Klettas D, Kapetanakis S, Monaghan MJ. Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy. Echo Res Pract 2016; 3:R1-R11. [PMID: 27249816 PMCID: PMC5402657 DOI: 10.1530/erp-15-0032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 11/08/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain) has conventionally been assessed using tissue Doppler imaging (TDI), which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference ('speckles') in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT.
Collapse
Affiliation(s)
- Sitara G Khan
- King's College London British Heart Foundation Centre, London, UK Department of Cardiology, King's College Hospital, London, UK
| | | | | | - Mark J Monaghan
- King's College London British Heart Foundation Centre, London, UK Department of Cardiology, King's College Hospital, London, UK
| |
Collapse
|
48
|
Rosa I, Marini C, Stella S, Ancona F, Spartera M, Margonato A, Agricola E. Mechanical dyssynchrony and deformation imaging in patients with functional mitral regurgitation. World J Cardiol 2016; 8:146-162. [PMID: 26981211 PMCID: PMC4766266 DOI: 10.4330/wjc.v8.i2.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/06/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic functional mitral regurgitation (FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy (DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle (LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy (CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.
Collapse
|
49
|
Is speckle tracking actually helpful for cardiac resynchronization therapy? J Echocardiogr 2016; 14:53-60. [PMID: 26767529 DOI: 10.1007/s12574-016-0275-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/09/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
What is the specific role of echocardiography in cardiac resynchronization therapy (CRT)? CRT has proven to be highly effective for improving symptoms and survival of patients with advanced heart failure (HF) and wide QRS. However, a significant minority of patients do not respond favorably to CRT on the basis of standard clinical selection criteria, including the electrocardiographic QRS width. Subsequently, echocardiographic assessment of left ventricular (LV) dyssynchrony has been considered useful for CRT for selected responders, but findings by multicenter studies suggest that its predictive value was not sufficiently robust to replace routine selection criteria for CRT. A more recent approach, however, using speckle-tracking echocardiography yields more accurate quantification of regional wall contraction. Speckle-tracking approaches have therefore generated a great deal of interest about their clinical applications for CRT. Although reports on speckle tracking have not been included in any recommendations as to whether patients should undergo CRT based on the current guidelines, speckle tracking can play an important supplementary part in CRT on the basis of a case-by-case clinical decision for challenging cases. Here, we review the strengths of speckle-tracking methods, and their current potential for clinical use in CRT.
Collapse
|
50
|
Gorcsan J, Tayal B. Newer Echocardiographic Techniques in Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2015; 7:609-618. [PMID: 26596806 DOI: 10.1016/j.ccep.2015.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Echocardiographic imaging plays a major role in patient selection for cardiac resynchronization therapy (CRT). One-third of patients do not respond; there is interest in advanced echocardiographic imaging to improve response. Current guidelines favor CRT for patients with electrocardiographic (ECG) QRS width of 150 milliseconds or greater and left bundle branch block. ECG criteria are imperfect; there is interest in advanced echocardiographic imaging to improve patient selection. This discussion focuses on newer echocardiographic methods to improve patient selection, improve delivery, and identify patients at risk for poor outcomes and serious ventricular arrhythmias.
Collapse
Affiliation(s)
- John Gorcsan
- Heart and Vascular Institute, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Bhupendar Tayal
- Heart and Vascular Institute, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|