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Wouters PC, Leenders GE, Cramer MJ, Meine M, Prinzen FW, Doevendans PA, De Boeck BWL. Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy. Int J Cardiovasc Imaging 2021; 37:1903-1911. [PMID: 33547623 PMCID: PMC8255256 DOI: 10.1007/s10554-021-02174-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. METHODS In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. RESULTS CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. CONCLUSION Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.
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Affiliation(s)
- Philippe C Wouters
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Geert E Leenders
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Maarten J Cramer
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Mathias Meine
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Frits W Prinzen
- Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | | | - Bart W L De Boeck
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.,Luzerner Kantonsspital, 6000, Luzern, Switzerland
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2
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Christoph J, Lebert J. Inverse mechano-electrical reconstruction of cardiac excitation wave patterns from mechanical deformation using deep learning. CHAOS (WOODBURY, N.Y.) 2020; 30:123134. [PMID: 33380038 DOI: 10.1063/5.0023751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
The inverse mechano-electrical problem in cardiac electrophysiology is the attempt to reconstruct electrical excitation or action potential wave patterns from the heart's mechanical deformation that occurs in response to electrical excitation. Because heart muscle cells contract upon electrical excitation due to the excitation-contraction coupling mechanism, the resulting deformation of the heart should reflect macroscopic action potential wave phenomena. However, whether the relationship between macroscopic electrical and mechanical phenomena is well-defined and unique enough to be utilized for an inverse imaging technique in which mechanical activation mapping is used as a surrogate for electrical mapping has yet to be determined. Here, we provide a numerical proof-of-principle that deep learning can be used to solve the inverse mechano-electrical problem in phenomenological two- and three-dimensional computer simulations of the contracting heart wall, or in elastic excitable media, with muscle fiber anisotropy. We trained a convolutional autoencoder neural network to learn the complex relationship between electrical excitation, active stress, and tissue deformation during both focal or reentrant chaotic wave activity and, consequently, used the network to successfully estimate or reconstruct electrical excitation wave patterns from mechanical deformation in sheets and bulk-shaped tissues, even in the presence of noise and at low spatial resolutions. We demonstrate that even complicated three-dimensional electrical excitation wave phenomena, such as scroll waves and their vortex filaments, can be computed with very high reconstruction accuracies of about 95% from mechanical deformation using autoencoder neural networks, and we provide a comparison with results that were obtained previously with a physics- or knowledge-based approach.
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Affiliation(s)
- Jan Christoph
- Department of Cardiology and Pneumology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Jan Lebert
- Department of Cardiology and Pneumology, University Medical Center Göttingen, 37075 Göttingen, Germany
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3
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Shradhanjali A, Riehl BD, Duan B, Yang R, Lim JY. Spatiotemporal Characterizations of Spontaneously Beating Cardiomyocytes with Adaptive Reference Digital Image Correlation. Sci Rep 2019; 9:18382. [PMID: 31804542 PMCID: PMC6895104 DOI: 10.1038/s41598-019-54768-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022] Open
Abstract
We developed an Adaptive Reference-Digital Image Correlation (AR-DIC) method that enables unbiased and accurate mechanics measurements of moving biological tissue samples. We applied the AR-DIC analysis to a spontaneously beating cardiomyocyte (CM) tissue, and could provide correct quantifications of tissue displacement and strain for the beating CMs utilizing physiologically-relevant, sarcomere displacement length-based contraction criteria. The data were further synthesized into novel spatiotemporal parameters of CM contraction to account for the CM beating homogeneity, synchronicity, and propagation as holistic measures of functional myocardial tissue development. Our AR-DIC analyses may thus provide advanced non-invasive characterization tools for assessing the development of spontaneously contracting CMs, suggesting an applicability in myocardial regenerative medicine.
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Grants
- P20 GM104320 NIGMS NIH HHS
- P20 GM113126 NIGMS NIH HHS
- P30 GM127200 NIGMS NIH HHS
- U54 GM115458 NIGMS NIH HHS
- American Heart Association (American Heart Association, Inc.)
- National Science Foundation (NSF)
- NIH/NIGMS Nebraska Center for Integrated Biomolecular Communication (NCIBC) (P20GM113126, PI: Takacs), NIH/NIGMS Nebraska Center for Nanomedicine (P30GM127200, PI: Bronich), Nebraska Collaborative Initiative (PI: Yang)
- NSF | ENG/OAD | Division of Chemical, Bioengineering, Environmental, and Transport Systems (CBET)
- NE DHHS Stem Cell Research Project (2018-07, PI: Lim); UNL Layman New Directions Award (PI: Lim); NIH/NIGMS COBRE NPOD Seed Grant (P20GM104320, PI: Zempleni); NIH/NIGMS Great Plains IDeA-CTR Pilot Grant (1U54GM115458-01, PI: Rizzo)
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Affiliation(s)
- Akankshya Shradhanjali
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Brandon D Riehl
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Bin Duan
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Ruiguo Yang
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Nebraska Center for Integrated Biomolecular Communication, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Jung Yul Lim
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA.
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
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4
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Aalen JM, Remme EW, Larsen CK, Andersen OS, Krogh M, Duchenne J, Hopp E, Ross S, Beela AS, Kongsgaard E, Bergsland J, Odland HH, Skulstad H, Opdahl A, Voigt JU, Smiseth OA. Mechanism of Abnormal Septal Motion in Left Bundle Branch Block. JACC Cardiovasc Imaging 2019; 12:2402-2413. [DOI: 10.1016/j.jcmg.2018.11.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 12/28/2022]
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5
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Piorkowski C, Breithardt OA, Razavi H, Nabutovsky Y, Rosenberg SP, Markovitz CD, Arya A, Rolf S, John S, Kosiuk J, Olson E, Eitel C, Huo Y, Döring M, Richter S, Ryu K, Gaspar T, Prinzen FW, Hindricks G, Sommer P. Mapping-guided characterization of mechanical and electrical activation patterns in patients with normal systolic function using a sensor-based tracking technology. Europace 2017; 19:1700-1709. [PMID: 27738070 DOI: 10.1093/europace/euw261] [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: 03/24/2016] [Accepted: 07/29/2016] [Indexed: 11/14/2022] Open
Abstract
Aims In times of evolving cardiac resynchronization therapy, intra-procedural characterization of left ventricular (LV) mechanical activation patterns is desired but technically challenging with currently available technologies. In patients with normal systolic function, we evaluated the feasibility of characterizing LV wall motion using a novel sensor-based, real-time tracking technology. Methods and results Ten patients underwent simultaneous motion and electrical mapping of the LV endocardium during sinus rhythm using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™, SJM). Epicardial motion data were also collected simultaneously at corresponding locations from accessible coronary sinus branches. Displacements at each mapping point and times of electrical and mechanical activation were combined over each of the six standard LV wall segments. Mechanical activation timing was compared with that from electrical activation and preoperative 2D speckle tracking echocardiography (echo). MediGuide-based displacement data were further analysed to estimate LV chamber volumes that were compared with echo and magnetic resonance imaging (MRI). The lateral and septal walls exhibited the largest (12.5 [11.6-15.0] mm) and smallest (10.2 [9.0-11.3] mm) displacement, respectively. Radial displacement was significantly larger endocardially than epicardially (endo: 6.7 [5.0-9.1] mm; epi: 3.8 [2.4-5.6] mm), while longitudinal displacement was significantly larger epicardially (endo: 8.0 [5.0-10.6] mm; epi: 10.3 [7.4-13.8] mm). Most often, the anteroseptal/anterior and lateral walls showed the earliest and latest mechanical activations, respectively. 9/10 patients had concordant or adjacent wall segments of latest mechanical and electrical activation, and 6/10 patients had concordant or adjacent wall segments of latest mechanical activation as measured by MediGuide and echo. MediGuide's LV chamber volumes were significantly correlated with MRI (R2= 0.73, P < 0.01) and echo (R2= 0.75, P < 0.001). Conclusion The feasibility of mapping-guided intra-procedural characterization of LV wall motion was established. Clinical trial registration http://www.clinicaltrials.gov; Unique identifier: CT01629160.
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Affiliation(s)
- Christopher Piorkowski
- Department of Invasive Electrophysiology, University of Dresden-Heart Center, Dresden, Germany
| | - Ole-A Breithardt
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | | | | | | | | | - Arash Arya
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Silke John
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Jedrzej Kosiuk
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | | | - Charlotte Eitel
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Yan Huo
- Department of Invasive Electrophysiology, University of Dresden-Heart Center, Dresden, Germany
| | - Michael Döring
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | | | - Thomas Gaspar
- Department of Invasive Electrophysiology, University of Dresden-Heart Center, Dresden, Germany
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
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6
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van Middendorp LB, Kuiper M, Munts C, Wouters P, Maessen JG, van Nieuwenhoven FA, Prinzen FW. Local microRNA-133a downregulation is associated with hypertrophy in the dyssynchronous heart. ESC Heart Fail 2017; 4:241-251. [PMID: 28772031 PMCID: PMC5542733 DOI: 10.1002/ehf2.12154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/18/2017] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
Aims Left bundle branch block (LBBB) creates considerable regional differences in mechanical load within the left ventricle (LV). We investigated expression of selected microRNAs (miRs) in relation to regional hypertrophy and fibrosis in LBBB hearts and their reversibility upon cardiac resynchronization therapy (CRT). Methods and results Eighteen dogs were followed for 4 months after induction of LBBB, 10 of which received CRT after 2 months. Five additional dogs served as control. LV geometric changes were determined by echocardiography and myocardial strain by magnetic resonance imaging tagging. Expression levels of miRs, their target genes: connective tissue growth factor (CTGF), serum response factor (SRF), nuclear factor of activated T cells (NFATc4), and cardiomyocyte diameter and collagen deposition were measured in the septum and LV free wall (LVfw). In LBBB hearts, LVfw and septal systolic circumferential strain were 200% and 50% of control, respectively. This coincided with local hypertrophy in the LVfw. MiR‐133a expression was reduced by 33% in the LVfw, which corresponded with a selective increase of CTGF expression in the LVfw (279% of control). By contrast, no change was observed in SRF and NFATc4 expression was decreased in LBBB hearts. CRT normalized strain patterns and reversed miR‐133a and CTGF expression towards normal, expression of other miRs, related to remodelling, such as miR‐199b and miR‐155f, were not affected. Conclusions In the clinically relevant large animal model of LBBB, a close inverse relation exists between local hypertrophy and miR‐133a. Reduced miR‐133a correlated with increased CTGF levels but not with SRF and NFATc4.
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Affiliation(s)
- Lars B van Middendorp
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Marion Kuiper
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Chantal Munts
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Philippe Wouters
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Frans A van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Limburg, The Netherlands
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7
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Hsu YL, Huang HP. Two-dimensional speckle-tracking echocardiographic assessment of left ventricular mechanical synchrony in clinically normal cats. VETERINARY MEDICINE-RESEARCH AND REPORTS 2016; 7:33-40. [PMID: 30050835 PMCID: PMC6042560 DOI: 10.2147/vmrr.s97634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ventricular heterogeneity and synchrony are associated with hypertrophic cardiomyopathy in humans. Hypertrophic cardiomyopathy is commonly observed in cats. The aim of this study was to determine the presence and normal range of left ventricular mechanical heterogeneity and synchrony in clinically healthy cats using two-dimensional speckle-tracking echocardiography. Thirty-four clinically healthy cats were included in this prospective study. Two-dimensional echocardiography and two-dimensional speckle-tracking echocardiography were performed on all cats. Echocardiographic parameters, including circumferential, radial, and longitudinal strain and strain rate, heterogeneity, and synchrony, were measured. Segmental heterogeneity values in the circumferential, radial, and longitudinal directions were 13.1%±5.9%, 19.1%±10.3%, and 15.4%±6.8%, respectively. Transmural heterogeneity was -14.3%±4.6% in the circumferential direction. Left ventricular synchrony values in the circumferential, radial, and longitudinal directions were 11.7±4.2, 16.5±13.4, and 19.4±8.5 ms, respectively. Inter-ventricular synchrony was -3.9±13.2 ms. Left ventricular heterogeneity and synchrony were noted in clinically healthy cats; segmental heterogeneity, which is characterized as longitudinal, progressively increased from the apical to the basal segments, while transmural heterogeneity, which is characterized as circumferential, progressively decreased from the endocardium to the epicardium.
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Affiliation(s)
- Yueh-Lun Hsu
- Institute of Veterinary Clinical Science, Veterinary School, National Taiwan University, Taipei, Taiwan,
| | - Hui-Pi Huang
- Institute of Veterinary Clinical Science, Veterinary School, National Taiwan University, Taipei, Taiwan,
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Silva E, Bijnens B, Berruezo A, Mont L, Doltra A, Andreu D, Brugada J, Sitges M. Integración de la imagen mecánica, estructural y eléctrica para entender la respuesta a la terapia de resincronización cardiaca. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Silva E, Bijnens B, Berruezo A, Mont L, Doltra A, Andreu D, Brugada J, Sitges M. Integration of mechanical, structural and electrical imaging to understand response to cardiac resynchronization therapy. ACTA ACUST UNITED AC 2014; 67:813-21. [PMID: 25262127 DOI: 10.1016/j.rec.2013.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is extensive controversy exists on whether cardiac resynchronization therapy corrects electrical or mechanical asynchrony. The aim of this study was to determine if there is a correlation between electrical and mechanical sequences and if myocardial scar has any relevant impact. METHODS Six patients with normal left ventricular function and 12 patients with left ventricular dysfunction and left bundle branch block, treated with cardiac resynchronization therapy, were studied. Real-time three-dimensional echocardiography and electroanatomical mapping were performed in all patients and, where applicable, before and after therapy. Magnetic resonance was performed for evaluation of myocardial scar. Images were postprocessed and mechanical and electrical activation sequences were defined and time differences between the first and last ventricular segment to be activated were determined. Response to therapy was defined as a reduction in left ventricular end-systolic volume ≥ 15% after 12 months of follow-up. RESULTS Good correlation between electrical and mechanical timings was found in patients with normal left ventricular function (r(2) = 0.88; P = .005) but not in those with left ventricular dysfunction (r(2) = 0.02; P = not significant). After therapy, both timings and sequences were modified and improved, except in those with myocardial scar. CONCLUSIONS Despite a close electromechanical relationship in normal left ventricular function, there is no significant correlation in patients with dysfunction. Although resynchronization therapy improves this correlation, the changes in electrical activation may not yield similar changes in left ventricular mechanics particularly depending on the underlying myocardial substrate.
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Affiliation(s)
- Etelvino Silva
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Bart Bijnens
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Berruezo
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Lluis Mont
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Adelina Doltra
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - David Andreu
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Josep Brugada
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Marta Sitges
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
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Leyva F, Nisam S, Auricchio A. 20 Years of Cardiac Resynchronization Therapy. J Am Coll Cardiol 2014; 64:1047-58. [DOI: 10.1016/j.jacc.2014.06.1178] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/15/2014] [Accepted: 06/17/2014] [Indexed: 01/14/2023]
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Shimamoto S, Ito T, Nogi S, Kizawa S, Ishizaka N. Left Ventricular Mechanical Discoordination in Nonischemic Hearts: Relationship with Left Ventricular Function, Geometry, and Electrical Dyssynchrony. Echocardiography 2014; 31:1077-84. [DOI: 10.1111/echo.12538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Takahide Ito
- Department of Cardiology; Osaka Medical College; Osaka Japan
| | - Shimpei Nogi
- Department of Cardiology; Osaka Medical College; Osaka Japan
| | - Shun Kizawa
- Department of Cardiology; Osaka Medical College; Osaka Japan
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Foell D, Jung BA, Germann E, Staehle F, Bode C, Hennig J, Markl M. Segmental myocardial velocities in dilated cardiomyopathy with and without left bundle branch block. J Magn Reson Imaging 2012; 37:119-26. [DOI: 10.1002/jmri.23803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 08/03/2012] [Indexed: 11/07/2022] Open
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Hermeling E, Delhaas T, Prinzen FW, Kuijpers NHL. Mechano-electrical feedback explains T-wave morphology and optimizes cardiac pump function: insight from a multi-scale model. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2012; 110:359-71. [PMID: 22835663 DOI: 10.1016/j.pbiomolbio.2012.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/16/2012] [Indexed: 11/17/2022]
Abstract
In the ECG, T- and R-wave are concordant during normal sinus rhythm (SR), but discordant after a period of ventricular pacing (VP). Experiments showed that the latter phenomenon, called T-wave memory, is mediated by a mechanical stimulus. By means of a mathematical model, we investigated the hypothesis that slow acting mechano-electrical feedback (MEF) explains T-wave memory. In our model, electromechanical behavior of the left ventricle (LV) was simulated using a series of mechanically and electrically coupled segments. Each segment comprised ionic membrane currents, calcium handling, and excitation-contraction coupling. MEF was incorporated by locally adjusting conductivity of L-type calcium current (g(CaL)) to local external work. In our set-up, g(CaL) could vary up to 25%, 50%, 100% or unlimited amount around its default value. Four consecutive simulations were performed: normal SR (with MEF), acute VP, sustained VP (with MEF), and acutely restored SR. MEF led to T-wave concordance in normal SR and to discordant T-waves acutely after restoring SR. Simulated ECGs with a maximum of 25-50% adaptation closely resembled those during T-wave memory experiments in vivo and also provided the best compromise between optimal systolic and diastolic function. In conclusion, these simulation results indicate that slow acting MEF in the LV can explain a) the relatively small differences in systolic shortening and mechanical work during SR, b) the small dispersion in repolarization time, c) the concordant T-wave during SR, and d) T-wave memory. The physiological distribution in electrophysiological properties, reflected by the concordant T-wave, may serve to optimize cardiac pump function.
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Affiliation(s)
- Evelien Hermeling
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
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14
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Leenders GE, Lumens J, Cramer MJ, De Boeck BW, Doevendans PA, Delhaas T, Prinzen FW. Septal Deformation Patterns Delineate Mechanical Dyssynchrony and Regional Differences in Contractility. Circ Heart Fail 2012; 5:87-96. [DOI: 10.1161/circheartfailure.111.962704] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Response to cardiac resynchronization therapy depends both on dyssynchrony and (regional) contractility. We hypothesized that septal deformation can be used to infer integrated information on dyssynchrony and regional contractility, and thereby predict cardiac resynchronization therapy response.
Methods and Results—
In 132 cardiac resynchronization therapy candidates with left bundle branch block (LBBB)-like electrocardiogram morphology (left ventricular ejection fraction 19±6%; QRS width 170±23 ms), longitudinal septal strain was assessed by speckle tracking echocardiography. To investigate the effects of dyssynchronous activation and differences in septal and left ventricular free wall contractility on septal deformation pattern, we used the CircAdapt computer model of the human heart and circulation. In the patients, 3 characteristic septal deformation patterns were identified: LBBB-1=double-peaked systolic shortening (n=28); LBBB-2=early systolic shortening followed by prominent systolic stretching (n=34); and LBBB-3=pseudonormal shortening with less pronounced late systolic stretch (n=70). LBBB-3 revealed more scar (2 [2–5] segments) compared with LBBB-1 and LBBB-2 (both 0 [0–1],
P
<0.05). In the model, imposing a time difference of activation between septum and left ventricular free wall resulted in pattern LBBB-1. This transformed into pattern LBBB-2 by additionally simulating septal hypocontractility, and into pattern LBBB-3 by imposing additional left ventricular free wall or global left ventricular hypocontractility. Improvement of left ventricular ejection fraction and reduction of left ventricular volumes after cardiac resynchronization therapy were most pronounced in LBBB-1 and worst in LBBB-3 patients.
Conclusions—
A double-peaked systolic septal deformation pattern is characteristic for LBBB and results from intraventricular dyssynchrony. Abnormal contractility modifies this pattern. A computer model can be helpful in understanding septal deformation and predicting cardiac resynchronization therapy response.
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Affiliation(s)
- Geert E. Leenders
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Joost Lumens
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Maarten J. Cramer
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Bart W.L. De Boeck
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Pieter A. Doevendans
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Tammo Delhaas
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Frits W. Prinzen
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
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15
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Donahue T, Niazi I, Leon A, Stucky M, Herrmann K. Acute and Chronic Response to CRT in Narrow QRS Patients. J Cardiovasc Transl Res 2011; 5:232-41. [DOI: 10.1007/s12265-011-9338-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
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16
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Abstract
Abnormal electrical activation of the ventricles creates major abnormalities in cardiac mechanics. Local contraction patterns, as reflected by measurements of local strain, are not only out of phase, but often also show opposing length changes in early and late activated regions. As a consequence, the efficiency of cardiac pump function (the amount of stroke work generated by a unit of oxygen consumed) is approximately 30% lower in asynchronous than in synchronous hearts. Moreover, the amount of work performed in myocardial segments becomes considerably larger in late than in early activated regions. Cardiac Resynchronization Therapy (CRT) improves mechano-energetics of the previously asynchronous heart in various ways: it alleviates impediment of the abnormal contraction on blood flow, it increases myocardial efficiency, it recruits contraction in the previously early activated septum and it creates a more uniform distribution of myocardial blood flow. These factors act together to increase the range of cardiac work that can be delivered by the patients’ heart, an effect that can explain the increased exercise tolerance and quality of life reported in several CRT trials.
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Affiliation(s)
- Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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17
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Echocardiographic prediction of outcome after cardiac resynchronization therapy: conventional methods and recent developments. Heart Fail Rev 2011; 16:235-50. [PMID: 21104122 PMCID: PMC3074077 DOI: 10.1007/s10741-010-9200-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Echocardiography plays an important role in patient assessment before cardiac resynchronization therapy (CRT) and can monitor many of its mechanical effects in heart failure patients. Encouraged by the highly variable individual response observed in the major CRT trials, echocardiography-based measurements of mechanical dyssynchrony have been extensively investigated with the aim of improving response prediction and CRT delivery. Despite recent setbacks, these techniques have continued to develop in order to overcome some of their initial flaws and limitations. This review discusses the concepts and rationale of the available echocardiographic techniques, highlighting newer quantification methods and discussing some of the unsolved issues that need to be addressed.
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18
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The use of echocardiography in Wolff–Parkinson–White syndrome. Int J Cardiovasc Imaging 2011; 28:725-34. [DOI: 10.1007/s10554-011-9880-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
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19
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The role of echocardiography in patient selection for CRT: the switch from motion to understanding regional ventricular function. Neth Heart J 2011; 18:572-3. [PMID: 21301618 DOI: 10.1007/s12471-010-0837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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20
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Iwano H, Yamada S, Watanabe M, Mitsuyama H, Nishino H, Yokoyama S, Kaga S, Nishida M, Yokoshiki H, Onozuka H, Mikami T, Tsutsui H. Novel Strain Rate Index of Contractility Loss Caused by Mechanical Dyssynchrony - A Predictor of Response to Cardiac Resynchronization Therapy -. Circ J 2011; 75:2167-75. [DOI: 10.1253/circj.cj-10-1099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Masaya Watanabe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Hirofumi Mitsuyama
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Hisao Nishino
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Shinobu Yokoyama
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Sanae Kaga
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Mutsumi Nishida
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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21
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De Boeck BWL, Teske AJ, Leenders GE, Mohamed Hoesein FAA, Loh P, van Driel VJ, Doevendans PA, Prinzen FW, Cramer MJ. Detection and quantification by deformation imaging of the functional impact of septal compared to free wall preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 2010; 106:539-546.e2. [PMID: 20691313 DOI: 10.1016/j.amjcard.2010.03.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 11/30/2022]
Abstract
Pacing experiments in healthy animal hearts have suggested a larger detrimental effect of septal compared to free wall preexcitation. We investigated the intrinsic relation among the site of electrical preexcitation, mechanical dyssynchrony, and dysfunction in human patients. In 33 patients with Wolff-Parkinson-White (WPW) syndrome and 18 controls, regional myocardial deformation was assessed by speckle tracking mapping (ST-Map) to assess the preexcitation site, shortening sequences and dyssynchrony, and the extent of local and global ejecting shortening. The ST-Map data in patients with accessory atrioventricular pathways correctly diagnosed as located in the interventricular septum (IVS) (n = 11) or left ventricular free wall (LFW) (n = 12) were compared to the corresponding control values. A local ejecting shortening of <2 SD of the control values identified hypokinetic segments. The localization of the atrioventricular pathways by ST-Map matched with the invasive electrophysiology findings in 23 of 33 patients and was one segment different in 5 of 33 patients. In both WPW-IVS and WPW-LFW, local ejecting shortening was impaired at the preexcitation site (p <0.01). However, at similar electrical and mechanical dyssynchrony, WPW-IVS had more extensive hypokinesia than did WPW-LFW (3.6 +/- 0.9 vs 1.8 +/- 1.3 segments, p <0.01). Compared to controls, the left ventricular function was significantly reduced only in WPW-IVS (global ejecting shortening 17 +/- 2% vs 19 +/- 2%, p = 0.01; ejection fraction 55 +/- 5% vs 59 +/- 3%, p = 0.02). In conclusion, preexcitation is associated with local hypokinesia, which at comparable preexcitation is more extensive in WPW-IVS than in WPW-LFW and could adversely affect ventricular function. ST-Map might have a future role in detecting and guiding treatment of septal pathways with significant mechanical effects.
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22
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Reant P, Zaroui A, Donal E, Mignot A, Bordachar P, Deplagne A, Solnon A, Ritter P, Daubert JC, Clementy J, Leclercq C, Roudaut R, Habib G, Lafitte S. Identification and characterization of super-responders after cardiac resynchronization therapy. Am J Cardiol 2010; 105:1327-35. [PMID: 20403487 DOI: 10.1016/j.amjcard.2009.12.058] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 12/04/2009] [Accepted: 12/04/2009] [Indexed: 11/25/2022]
Abstract
Cardiac resynchronization therapy (CRT) has been shown to induce a spectacular effect on left ventricular (LV) function in certain patients. Our aim was to analyze and characterize the super-responders (SRs) to CRT using echocardiography in 186 patients with a conventional indication according to the European Society Cardiology guidelines. The investigation took place before and 6 months after implantation. CRT-SRs were defined by an improvement of the New York Heart Association functional class and LV ejection fraction to > or = 50% in absolute values associated with a relative LV end-systolic volume reduction of > or = 15%. Of the 186 patients, 18 (9.7%) were identified as CRT-SRs and had a significantly lower prevalence of ischemic etiology (11%), lower LV dimensions, lower left atrial volume, and greater global longitudinal strain at baseline. Receiver operating characteristics curves identified global longitudinal strain as the strongest parameter for predicting CRT-SRs, with a cutoff value of -12% (area under the curve 0.87, sensitivity 71%, and specificity 85%, p <0.01). In conclusion, in the present retrospective study, only a left atrial volume <55 ml and global longitudinal strain < or = -12% were independent predictors of CRT-SRs.
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23
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Nesser HJ, Winter S, Lang RM, Mor-Avi V. Echocardiographic techniques for the evaluation of left ventricular dyssynchrony. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Septal rebound stretch reflects the functional substrate to cardiac resynchronization therapy and predicts volumetric and neurohormonal response. Eur J Heart Fail 2009; 11:863-71. [DOI: 10.1093/eurjhf/hfp107] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Dandel M, Lehmkuhl H, Knosalla C, Suramelashvili N, Hetzer R. Strain and strain rate imaging by echocardiography - basic concepts and clinical applicability. Curr Cardiol Rev 2009; 5:133-48. [PMID: 20436854 PMCID: PMC2805816 DOI: 10.2174/157340309788166642] [Citation(s) in RCA: 262] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 09/23/2008] [Accepted: 09/23/2008] [Indexed: 12/13/2022] Open
Abstract
Echocardiographic strain and strain-rate imaging (deformation imaging) is a new non-invasive method for assessment of myocardial function. Due to its ability to differentiate between active and passive movement of myocardial segments, to quantify intraventricular dyssynchrony and to evaluate components of myocardial function, such as longitudinal myocardial shortening, that are not visually assessable, it allows comprehensive assessment of myocardial function and the spectrum of potential clinical applications is very wide. The high sensitivity of both tissue Doppler imaging (TDI) derived and two dimensional (2D) speckle tracking derived myocardial deformation (strain and strain rate) data for the early detection of myocardial dysfunction recommend these new non-invasive diagnostic methods for extensive clinical use. In addition to early detection and quantification of myocardial dysfunction of different etiologies, assessment of myocardial viability, detection of acute allograft rejection and early detection of allograft vasculopathy after heart transplantation, strain and strain rate data are helpful for therapeutic decisions and also useful for follow-up evaluations of therapeutic results in cardiology and cardiac surgery. Strain and strain rate data also provide valuable prognostic information, especially prediction of future reverse remodelling after left ventricular restoration surgery or after cardiac resynchronization therapy and prediction of short and median-term outcome without transplantation or ventricular assist device implantation of patients referred for heart transplantation.The Review explains the fundamental concepts of deformation imaging, describes in a comparative manner the two major deformation imaging methods (TDI-derived and speckle tracking 2D-strain derived) and discusses the clinical applicability of these new echocardiographic tools, which recently have become a subject of great interest for clinicians.
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Affiliation(s)
- Michael Dandel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany
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