51
|
van ’t Sant J, Fiolet ATL, ter Horst IAH, Cramer MJ, Mastenbroek MH, van Everdingen WM, Mast TP, Doevendans PA, Versteeg H, Meine M. Volumetric Response beyond Six Months of Cardiac Resynchronization Therapy and Clinical Outcome. PLoS One 2015; 10:e0124323. [PMID: 25933068 PMCID: PMC4416763 DOI: 10.1371/journal.pone.0124323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/02/2015] [Indexed: 01/14/2023] Open
Abstract
Aims Response to cardiac resynchronization therapy (CRT) is often assessed six months after implantation. Our objective was to assess the number of patients changing from responder to non-responder between six and 14 months, so-called late non-responders, and compare them to patients who were responder both at six and 14 months, so-called stable responders. Furthermore, we assessed predictive values of six and 14-month response concerning clinical outcome. Methods 105 patients eligible for CRT were enrolled. Clinical, laboratory, ECG, and echocardiographic parameters and patient-reported health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were assessed before, and six and 14 months after implantation. Response was defined as ≥15% LVESV decrease as compared to baseline. Major adverse cardiac events (MACE) were registered until 24 months after implantation. Predictive values of six and 14-month response for MACE were examined. Results In total, 75 (71%) patients were six-month responders of which 12 (16%) patients became late non-responder. At baseline, late non-responders more often had ischemic cardiomyopathy and atrial fibrillation, higher BNP and less dyssynchrony compared to stable responders. At six months, late non-responders showed significantly less LVESV decrease, and higher creatinine levels. Mean KCCQ scores of late non-responders were lower than those of stable responders at every time point, with the difference being significant at 14 months. The 14 months response was a better predictor of MACE than six months response. Conclusions The assessment of treatment outcomes after six months of CRT could be premature and response rates beyond might better correlate to long-term clinical outcome.
Collapse
Affiliation(s)
- Jetske van ’t Sant
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Aernoud T. L. Fiolet
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iris A. H. ter Horst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten J. Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mirjam H. Mastenbroek
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS—Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | | | - Thomas P. Mast
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS—Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
52
|
|
53
|
Comparison of septal strain patterns in dyssynchronous heart failure between speckle tracking echocardiography vendor systems. J Electrocardiol 2014; 48:609-16. [PMID: 25620788 DOI: 10.1016/j.jelectrocard.2014.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Indexed: 11/23/2022]
Abstract
AIM To analyze inter-vendor differences of speckle tracking echocardiography (STE) in imaging cardiac deformation in patients with dyssynchronous heart failure. METHODS AND RESULTS Eleven patients (all with LBBB, median age 60.7 years, 9 males) with implanted cardiac resynchronization therapy devices were prospectively included. Ultrasound systems of two vendors (i.e. General Electric and Philips) were used to record images in the apical four chamber view. Regional longitudinal strain patterns were analyzed with vendor specific software in the basal, mid and apical septal segments. Systolic strain (SS), time to peak strain (TTP) and septal rebound stretch (SRS) were determined during four pacing settings, resulting in 44 unique strain patterns per segment (total 132 patterns). Cross correlation was used to analyze the comparability of the shape of 132 normalized strain patterns. Correlation of strain patterns of the two systems was high (R(2) median: 0.68, interquartile range: 0.53-0.82). Accordingly, strain patterns of intrinsic rhythm were recognized equally using both systems, when divided into three types. GE based SS (18.9 ± 4.7%) was significantly higher than SS determined by the Philips system (13.4 ± 4.3%). TTP was slightly but non-significantly lower in GE (384 ± 77 ms) compared to Philips (404 ± 83 ms) derived strain signals. Correlation of SRS between the systems was poor, due to minor differences in the strain signal and timing of aortic valve closure. CONCLUSIONS The two systems provide similar shape of strain patterns. However, important differences are found in the amplitude, timing of systole and SRS. Until STE is standardized, clinical decision making should be restricted to pattern analysis.
Collapse
|
54
|
Sagara K. Ventriculoventricular delay optimization of a cardiac resynchronization device. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
|
55
|
Forsha D, Slorach C, Chen CK, Stephenson EA, Risum N, Hornik C, Wagner G, Mertens L, Barker P, Kisslo J, Friedberg MK. Classic-Pattern Dyssynchrony and Electrical Activation Delays in Pediatric Dilated Cardiomyopathy. J Am Soc Echocardiogr 2014; 27:956-64. [DOI: 10.1016/j.echo.2014.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Indexed: 11/28/2022]
|
56
|
Images as drivers of progress in cardiac computational modelling. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:198-212. [PMID: 25117497 PMCID: PMC4210662 DOI: 10.1016/j.pbiomolbio.2014.08.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/02/2014] [Indexed: 11/28/2022]
Abstract
Computational models have become a fundamental tool in cardiac research. Models are evolving to cover multiple scales and physical mechanisms. They are moving towards mechanistic descriptions of personalised structure and function, including effects of natural variability. These developments are underpinned to a large extent by advances in imaging technologies. This article reviews how novel imaging technologies, or the innovative use and extension of established ones, integrate with computational models and drive novel insights into cardiac biophysics. In terms of structural characterization, we discuss how imaging is allowing a wide range of scales to be considered, from cellular levels to whole organs. We analyse how the evolution from structural to functional imaging is opening new avenues for computational models, and in this respect we review methods for measurement of electrical activity, mechanics and flow. Finally, we consider ways in which combined imaging and modelling research is likely to continue advancing cardiac research, and identify some of the main challenges that remain to be solved.
Collapse
|
57
|
Vernooy K, van Deursen CJM, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol 2014; 11:481-93. [PMID: 24839977 DOI: 10.1038/nrcardio.2014.67] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.
Collapse
Affiliation(s)
- Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | | | - Marc Strik
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
| |
Collapse
|
58
|
Maréchaux S, Guiot A, Castel AL, Guyomar Y, Semichon M, Delelis F, Heuls S, Ennezat PV, Graux P, Tribouilloy C. Relationship between two-dimensional speckle-tracking septal strain and response to cardiac resynchronization therapy in patients with left ventricular dysfunction and left bundle branch block: a prospective pilot study. J Am Soc Echocardiogr 2014; 27:501-11. [PMID: 24513239 DOI: 10.1016/j.echo.2014.01.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have demonstrated variable patterns of longitudinal septal deformation in patients with left ventricular (LV) dysfunction and left bundle branch block. This prospective single center study was designed to assess the relationship between septal deformation patterns obtained by two-dimensional speckle-tracking echocardiography and response to cardiac resynchronization therapy (CRT). METHODS One hundred one patients with New York Heart Association class II to IV heart failure, LV ejection fractions ≤ 35%, and left bundle branch block underwent echocardiography before CRT. Longitudinal two-dimensional speckle-tracking strain analysis in the apical four-chamber view identified three patterns: double-peaked systolic shortening (pattern 1), early pre-ejection shortening peak followed by prominent systolic stretch (pattern 2), and pseudonormal shortening with a late systolic shortening peak and less pronounced end-systolic stretch (pattern 3). CRT response was defined as a relative reduction in LV end-systolic volume of ≥ 15% at 9-month follow-up. CRT super-response was defined as an absolute LV ejection fraction of ≥ 50% associated with a relative reduction in LV end-systolic volume of ≥ 15% and an improvement in New York Heart Association functional class. Cardiac death or hospitalization for heart failure during follow-up was systematically investigated. RESULTS Ninety-two percent of patients with pattern 1 or 2 were responders to CRT compared with 59% with pattern 3 (P < .0001). Thirty-six percent of patients with pattern 1 were super-responders compared with 15% of those with pattern 2 and 12% of those with pattern 3 (P = .037). The improvement in LV volumes, LV ejection fraction, and global longitudinal strain after CRT was better in patients with pattern 1 or 2 compared with those with pattern 3 (P < .0001 for all). Eighteen-month outcomes were excellent in patients with pattern 1 or 2, with event-free survival of 95 ± 3% compared with 75 ± 7% in patients with pattern 3 (P = .010). CONCLUSIONS Septal deformation strain pattern 1 or 2 is highly predictive of CRT response. Further studies are needed to identify predictors of "nonresponse" in patients with a pattern 3.
Collapse
Affiliation(s)
- Sylvestre Maréchaux
- Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France.
| | - Aurélie Guiot
- Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | - Anne Laure Castel
- Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | - Yves Guyomar
- Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | - Marc Semichon
- Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | - François Delelis
- Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | - Sebastien Heuls
- Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | | | - Pierre Graux
- Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, Lille, France
| | - Christophe Tribouilloy
- Pôle Cardiovasculaire et Thoracique, Centre Hospitalier Universitaire Amiens, Amiens, France; INSERM U 1088, Université de Picardie, Amiens, France
| |
Collapse
|
59
|
Bordachar P, Eschalier R, Lumens J, Ploux S. Optimal Strategies on Avoiding CRT Nonresponse. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:299. [PMID: 24633974 DOI: 10.1007/s11936-014-0299-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT The high rate of nonresponse to cardiac resynchronization therapy (CRT) has remained nearly unchanged since the treatment was introduced. We believe that this is directly related to the many persisting unknowns regarding the mechanical function of asynchronous hearts and the use of electrical stimulation to counteract the deleterious effects of that asynchrony. As a consequence, the key questions pertaining to the pre-implant, intra-implant, and postimplant phases remain unanswered or only partially answered. QRS duration is an imperfect selection criterion, as it does not discriminate the activation pattern. The inclusion of QRS morphology in the international professional practice guidelines is an important first step toward increasing the yield of this therapy. The invasive and the noninvasive electrical mapping techniques seem highly promising and need to be tested in large trials. The site of stimulation is a key element of the response to CRT; additional research must be pursued in this field.
Collapse
|
60
|
|
61
|
Affiliation(s)
- Frits W. Prinzen
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Kevin Vernooy
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Angelo Auricchio
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| |
Collapse
|
62
|
Circulation: Cardiovascular Imaging
Editors’ Picks. Circ Cardiovasc Imaging 2013. [DOI: 10.1161/circimaging.113.001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
63
|
Lumens J, Ploux S, Strik M, Gorcsan J, Cochet H, Derval N, Strom M, Ramanathan C, Ritter P, Haïssaguerre M, Jaïs P, Arts T, Delhaas T, Prinzen FW, Bordachar P. Comparative electromechanical and hemodynamic effects of left ventricular and biventricular pacing in dyssynchronous heart failure: electrical resynchronization versus left-right ventricular interaction. J Am Coll Cardiol 2013; 62:2395-2403. [PMID: 24013057 DOI: 10.1016/j.jacc.2013.08.715] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/11/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to enhance understanding of the working mechanism of cardiac resynchronization therapy by comparing animal experimental, clinical, and computational data on the hemodynamic and electromechanical consequences of left ventricular pacing (LVP) and biventricular pacing (BiVP). BACKGROUND It is unclear why LVP and BiVP have comparative positive effects on hemodynamic function of patients with dyssynchronous heart failure. METHODS Hemodynamic response to LVP and BiVP (% change in maximal rate of left ventricular pressure rise [LVdP/dtmax]) was measured in 6 dogs and 24 patients with heart failure and left bundle branch block followed by computer simulations of local myofiber mechanics during LVP and BiVP in the failing heart with left bundle branch block. Pacing-induced changes of electrical activation were measured in dogs using contact mapping and in patients using a noninvasive multielectrode electrocardiographic mapping technique. RESULTS LVP and BiVP similarly increased LVdP/dtmax in dogs and in patients, but only BiVP significantly decreased electrical dyssynchrony. In the simulations, LVP and BiVP increased total ventricular myofiber work to the same extent. While the LVP-induced increase was entirely due to enhanced right ventricular (RV) myofiber work, the BiVP-induced increase was due to enhanced myofiber work of both the left ventricle (LV) and RV. Overall, LVdP/dtmax correlated better with total ventricular myofiber work than with LV or RV myofiber work alone. CONCLUSIONS Animal experimental, clinical, and computational data support the similarity of hemodynamic response to LVP and BiVP, despite differences in electrical dyssynchrony. The simulations provide the novel insight that, through ventricular interaction, the RV myocardium importantly contributes to the improvement in LV pump function induced by cardiac resynchronization therapy.
Collapse
Affiliation(s)
- Joost Lumens
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Marc Strik
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - John Gorcsan
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hubert Cochet
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | | | | | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Theo Arts
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Tammo Delhaas
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Frits W Prinzen
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| |
Collapse
|
64
|
Oh JK, Vatury OM, Wang CL. Identification of Wasted Energy Is a Key to Predict Positive Response to Cardiac Resynchronization Therapy. Circ Cardiovasc Imaging 2013; 6:159-61. [DOI: 10.1161/circimaging.113.000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jae K. Oh
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., O.V.); and the First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-L.W.)
| | - Ori M. Vatury
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., O.V.); and the First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-L.W.)
| | - Chun-Li Wang
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., O.V.); and the First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-L.W.)
| |
Collapse
|
65
|
Manifold Learning Characterization of Abnormal Myocardial Motion Patterns: Application to CRT-Induced Changes. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/978-3-642-38899-6_53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
66
|
Duchateau N, Doltra A, Silva E, De Craene M, Piella G, Castel MÁ, Mont L, Brugada J, Frangi AF, Sitges M. Atlas-based quantification of myocardial motion abnormalities: added-value for understanding the effect of cardiac resynchronization therapy. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:2186-2197. [PMID: 23069133 DOI: 10.1016/j.ultrasmedbio.2012.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 07/27/2012] [Accepted: 08/11/2012] [Indexed: 06/01/2023]
Abstract
Statistical atlases may help improving the analysis of cardiac wall-motion abnormalities. This study aims at demonstrating the clinical value of such a method to better understand the effect of cardiac resynchronization therapy (CRT). We compared an atlas of normal septal motion built using apical four-chamber two-dimensional echocardiographic sequences from healthy volunteers with 88 patients undergoing CRT at baseline and at 12 months follow-up. Abnormal motion was quantified locally using a p value based on a statistical distance to normality. Reduction ≥15% in left ventricle end-systolic volume defined CRT response. Responders showed significantly higher reduction of abnormalities (p ≤ 0.001). Non-responders conserved abnormal septal motion at the end of the isovolumic contraction (IVC). A specific inward-outward motion of the septum during IVC predominated in responders and was corrected at follow-up. The method is of interest to characterize patterns of mechanical dyssynchrony and to study the link between their evolution and CRT response.
Collapse
Affiliation(s)
- Nicolas Duchateau
- Center for Computational Imaging and Simulation Technologies in Biomedicina, Universitat Pompeu Fabra and Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
67
|
Nijjer SS, Pabari PA, Stegemann B, Palmieri V, Leyva F, Linde C, Freemantle N, Davies JE, Hughes AD, Francis DP. The Limit of Plausibility for Predictors of Response: Application to Biventricular Pacing. JACC Cardiovasc Imaging 2012; 5:1046-65. [DOI: 10.1016/j.jcmg.2012.07.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 07/05/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
|