1
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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.
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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
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2
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Sidhu BS, Lee AWC, Gould J, Porter B, Sieniewicz B, Elliott MK, Mehta VS, Wijesuriya N, Amadou AA, Plank G, Haberland U, Rajani R, Rinaldi CA, Niederer SA. Guided implantation of a leadless left ventricular endocardial electrode and acoustic transmitter using computed tomography anatomy, dynamic perfusion and mechanics, and predicted activation pattern. Heart Rhythm 2023; 20:1481-1488. [PMID: 37453603 PMCID: PMC10850882 DOI: 10.1016/j.hrthm.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/28/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The WiSE-CRT System (EBR systems, Sunnyvale, CA) permits leadless left ventricular pacing. Currently, no intraprocedural guidance is used to target optimal electrode placement while simultaneously guiding acoustic transmitter placement in close proximity to the electrode to ensure adequate power delivery. OBJECTIVE The purpose of this study was to assess the use of computed tomography (CT) anatomy, dynamic perfusion and mechanics, and predicted activation pattern to identify both the optimal electrode and transmitter locations. METHODS A novel CT protocol was developed using preprocedural imaging and simulation to identify target segments (TSs) for electrode implantation, with late electrical and mechanical activation, with ≥5 mm wall thickness without perfusion defects. Modeling of the acoustic intensity from different transmitter implantation sites to the TSs was used to identify the optimal transmitter location. During implantation, TSs were overlaid on fluoroscopy to guide optimal electrode location that were evaluated by acute hemodynamic response (AHR) by measuring the maximal rate of left ventricular pressure rise with biventricular pacing. RESULTS Ten patients underwent the implantation procedure. The transmitter could be implanted within the recommended site on the basis of preprocedural analysis in all patients. CT identified a mean of 4.8 ± 3.5 segments per patient with wall thickness < 5 mm. During electrode implantation, biventricular pacing within TSs resulted in a significant improvement in AHR vs non-TSs (25.5% ± 8.8% vs 12.9% ± 8.6%; P < .001). Pacing in CT-identified scar resulted in either failure to capture or minimal AHR improvement. The electrode was targeted to the TSs in all patients and was implanted in the TSs in 80%. CONCLUSION Preprocedural imaging and modeling data with intraprocedural guidance can successfully guide WiSE-CRT electrode and transmitter implantation to allow optimal AHR and adequate power delivery.
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Affiliation(s)
- Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Angela W C Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Bradley Porter
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Benjamin Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Ulrike Haberland
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Siemens Healthcare GmbH, Forchheim, Germany
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom; The Alan Turing Institute, London, United Kingdom
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3
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Akhtar Z, Gallagher MM, Kontogiannis C, Leung LWM, Spartalis M, Jouhra F, Sohal M, Shanmugam N. Progress in Cardiac Resynchronisation Therapy and Optimisation. J Cardiovasc Dev Dis 2023; 10:428. [PMID: 37887875 PMCID: PMC10607614 DOI: 10.3390/jcdd10100428] [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: 09/03/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Cardiac resynchronisation therapy (CRT) has become the cornerstone of heart failure (HF) treatment. Despite the obvious benefit from this therapy, an estimated 30% of CRT patients do not respond ("non-responders"). The cause of "non-response" is multi-factorial and includes suboptimal device settings. To optimise CRT settings, echocardiography has been considered the gold standard but has limitations: it is user dependent and consumes time and resources. CRT proprietary algorithms have been developed to perform device optimisation efficiently and with limited resources. In this review, we discuss CRT optimisation including the various adopted proprietary algorithms and conduction system pacing.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George’s University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Mark M. Gallagher
- Department of Cardiology, St George’s University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Christos Kontogiannis
- Department of Cardiology, St George’s University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Lisa W. M. Leung
- Department of Cardiology, St George’s University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Michael Spartalis
- Department of Cardiology, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Fadi Jouhra
- Department of Cardiology, St George’s University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Manav Sohal
- Department of Cardiology, St George’s University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Nesan Shanmugam
- Department of Cardiology, St George’s University Hospital, Blackshaw Road, London SW17 0QT, UK
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4
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Hara H, Igarashi T, Kaida T, Murakami M, Ito H, Niwano S, Ako J. Estimation of left ventricular activation sequence in patients with heart failure using two-dimensional speckle tracking echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1251-1262. [PMID: 36971867 DOI: 10.1007/s10554-023-02834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/10/2023] [Indexed: 06/09/2023]
Abstract
Evaluation of longitudinal strain (LS) from two-dimensional echocardiography is useful for global and regional left ventricular (LV) dysfunction assessment. We determined whether the LS reflects contraction process in patients with asynchronous LV activation. We studied 144 patients with an ejection fraction ≤ 35%, who had left bundle branch block (LBBB, n = 42), right ventricular apical (RVA) pacing (n = 34), LV basal- or mid-lateral pacing (n = 23), and no conduction block (Narrow-QRS, n = 45). LS distribution maps were constructed using 3 standard apical views. The times from the QRS onset-to-early systolic positive peak (Q-EPpeak) and late systolic negative peak (Q-LNpeak) were measured to determine the beginning and end of contractions in each segment. Negative strain in LBBB initially appeared in the septum and basal-lateral contracted late. In RVA and LV pacing, the contracted area enlarged centrifugally from the pacing site. Narrow-QRS showed few regional differences in strain during the systolic period. The Q-EPpeak and Q-LNpeak exhibited similar sequences characterized by septum to basal-lateral via the apical regions in LBBB, apical to basal regions in RVA pacing, and lateral to a relatively large delayed contracted area between the apical- and basal-septum in LV pacing. Differences in Q-LNpeaks between the apical and basal segments in delayed contracted wall were 107 ± 30 ms in LBBB, 133 ± 46 ms in RVA pacing, and 37 ± 20 ms in LV pacing (p < 0.05, between QRS groups). Specific LV contraction processes were demonstrated by evaluating the LS distribution and time-to-peak strain. These evaluations may have potential to estimate the activation sequence in patients with asynchronous LV activation.
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Affiliation(s)
- Hideyuki Hara
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan.
| | - Tazuru Igarashi
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Toyoji Kaida
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Masami Murakami
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Hiroshi Ito
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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5
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Sabouri M, Hajianfar G, Hosseini Z, Amini M, Mohebi M, Ghaedian T, Madadi S, Rastgou F, Oveisi M, Bitarafan Rajabi A, Shiri I, Zaidi H. Myocardial Perfusion SPECT Imaging Radiomic Features and Machine Learning Algorithms for Cardiac Contractile Pattern Recognition. J Digit Imaging 2023; 36:497-509. [PMID: 36376780 PMCID: PMC10039187 DOI: 10.1007/s10278-022-00705-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
A U-shaped contraction pattern was shown to be associated with a better Cardiac resynchronization therapy (CRT) response. The main goal of this study is to automatically recognize left ventricular contractile patterns using machine learning algorithms trained on conventional quantitative features (ConQuaFea) and radiomic features extracted from Gated single-photon emission computed tomography myocardial perfusion imaging (GSPECT MPI). Among 98 patients with standard resting GSPECT MPI included in this study, 29 received CRT therapy and 69 did not (also had CRT inclusion criteria but did not receive treatment yet at the time of data collection, or refused treatment). A total of 69 non-CRT patients were employed for training, and the 29 were employed for testing. The models were built utilizing features from three distinct feature sets (ConQuaFea, radiomics, and ConQuaFea + radiomics (combined)), which were chosen using Recursive feature elimination (RFE) feature selection (FS), and then trained using seven different machine learning (ML) classifiers. In addition, CRT outcome prediction was assessed by different treatment inclusion criteria as the study's final phase. The MLP classifier had the highest performance among ConQuaFea models (AUC, SEN, SPE = 0.80, 0.85, 0.76). RF achieved the best performance in terms of AUC, SEN, and SPE with values of 0.65, 0.62, and 0.68, respectively, among radiomic models. GB and RF approaches achieved the best AUC, SEN, and SPE values of 0.78, 0.92, and 0.63 and 0.74, 0.93, and 0.56, respectively, among the combined models. A promising outcome was obtained when using radiomic and ConQuaFea from GSPECT MPI to detect left ventricular contractile patterns by machine learning.
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Affiliation(s)
- Maziar Sabouri
- Department of Medical Physics, School of Medicine, Iran University of Medical Science, Tehran, Iran
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Ghasem Hajianfar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Zahra Hosseini
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mehdi Amini
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Mobin Mohebi
- Department of Biomedical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Tahereh Ghaedian
- Nuclear Medicine and Molecular Imaging Research Center, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shabnam Madadi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Fereydoon Rastgou
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mehrdad Oveisi
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Computer Science, University of British Columbia, Vancouver BC, Canada
| | - Ahmad Bitarafan Rajabi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Cardiovascular Interventional Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland.
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland.
- Geneva University Neurocenter, Geneva University, Geneva, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
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6
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The role of cardiac magnetic resonance in identifying appropriate candidates for cardiac resynchronization therapy - a systematic review of the literature. Heart Fail Rev 2022; 27:2095-2118. [PMID: 36045189 DOI: 10.1007/s10741-022-10263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Abstract
Despite the strict indications for cardiac resynchronization therapy (CRT) implantation, a significant proportion of patients will fail to adequately respond to the treatment. This systematic review aims to present the existing evidence about the role of cardiac magnetic resonance (CMR) in identifying patients who are likely to respond better to the CRT. A systematic search in the MedLine database and Cochrane Library from their inception to August 2021 was performed, without any limitations, by two independent investigators. We considered eligible observational studies or randomized clinical trials (RCTs) that enrolled patients > 18 years old with heart failure (HF) of ischaemic or non-ischaemic aetiology and provided data about the association of baseline CMR variables with clinical or echocardiographic response to CRT for at least 3 months. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). Following our search strategy, 47 studies were finally included in our review. CMR appears to have an additive role in identifying the subgroup of patients who will respond better to CRT. Specifically, the presence and the extent of myocardial scar were associated with increased non-response rates, while those with no scar respond better. Furthermore, existing data show that scar location can be associated with CRT response rates. CMR-derived markers of mechanical desynchrony can also be used as predictors of CRT response. CMR data can be used to optimize the position of the left ventricular lead during the CRT implantation procedure. Specifically, positioning the left ventricular lead in a branch of the coronary sinus that feeds an area with transmural scar was associated with poorer response to CRT. CMR can be used as a non-invasive optimization tool to identify patients who are more likely to achieve better clinical and echocardiographic response following CRT implantation.
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Hu X, Qian Z, Zou F, Xue S, Zhang X, Wang Y, Hou X, Zhou W, Zou J. A Mild Dyssynchronous Contraction Pattern Detected by SPECT Myocardial Perfusion Imaging Predicts Super-Response to Cardiac Resynchronization Therapy. Front Cardiovasc Med 2022; 9:906467. [PMID: 35711371 PMCID: PMC9194389 DOI: 10.3389/fcvm.2022.906467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Using single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) with phase analysis (PA), we aimed to identify the predictive value of a new contraction pattern in cardiac resynchronization therapy (CRT) response. Methods Left ventricular mechanical dyssynchrony (LVMD) was evaluated using SPECT MPI with PA in non-ischemic dilated cardiomyopathy (DCM) patients with left bundle branch block (LBBB) indicated for CRT. CRT super-response was defined as LV ejection fraction (EF) ≥50% or an absolute increase of LVEF >15%. The LV contraction was categorized as the mild dyssynchronous pattern when the phase standard deviation (PSD) ≤ 40.3° and phase histogram bandwidth (PBW) ≤ 111.9°, otherwise it was defined as severe dyssynchronous pattern which was further characterized as U-shaped, heterogeneous or homogenous pattern. Results The final cohort comprised 74 patients, including 32 (43.2%) in mild dyssynchronous group, 17 (23%) in U-shaped group, 19 (25.7%) in heterogeneous group, and 6 (8.1%) in homogenous group. The mild dyssynchronous group had lower PSD and PBW than U-shaped, heterogeneous, and homogenous groups (P < 0.0001). Compared to patients with the heterogeneous pattern, the odds ratios (ORs) with 95% confidence intervals (CIs) for CRT super-response were 10.182(2.43–42.663), 12.8(2.545–64.372), and 2.667(0.327–21.773) for patients with mild dyssynchronous, U-shaped, and homogenous pattern, respectively. After multivariable adjustment, mild dyssynchronous group remained associated with increased CRT super-response (adjusted OR 5.709, 95% CI 1.152–28.293). Kaplan-Meier curves showed that mild dyssynchronous group demonstrated a better long-term prognosis. Conclusions The mild dyssynchronous pattern in patients with DCM is associated with an increased CRT super-response and better long-term prognosis.
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Affiliation(s)
- Xiao Hu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Cardiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fengwei Zou
- Montefiore Medical Center, Bronx, NY, United States
| | - Siyuan Xue
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinwei Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weihua Zhou
- College of Computing, Michigan Technological University, Houghton, MI, United States
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Jiangang Zou
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Chang S, He Y, Wang H, Guo F, Lv Q, Kang J, Bai R, Liu X, Du X, Ma C, Dong J. The Temporal Relation between Cardiomyopathy and LBBB and Response to Cardiac Resynchronization Therapy: Case Series and Literature Review. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2020. [DOI: 10.15212/cvia.2019.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Left bundle branch block (LBBB)-induced cardiomyopathy has been proposed, but the association between LBBB and cardiac resynchronization therapy (CRT) response remains unclear and practical criteria for selecting CRT candidates are needed.Methods: One hundred
and seventeen consecutive heart failure patients were reviewed, 24 of whom received CRT. Only two patients had a clear temporal relation between cardiomyopathy and LBBB.Results: Compared with the patient with “cardiomyopathy-induced LBBB,” the patient with “LBBB-induced
cardiomyopathy” had higher left ventricular (LV) wall thickness, higher LV wall thickening rate, higher peak circumferential strain, and longer peak circumferential strain delay. The LV deformation patterns in the two patients were obviously distinct on cardiovascular magnetic resonance
tissue tracking. During follow-up, the patient with LBBB-induced cardiomyopathy had a good response to CRT (LV ejection fraction 23 before CRT vs. 30% at 6 months vs. 29 at 12 months vs. 32% at 18 months; LV end-diastolic diameter 77 mm before CRT vs. 66 mm at 6 months vs. 62 mm at 12 months
vs. 63 mm at 18 months), and the other patient had no response to CRT (LV ejection fraction 29 before CRT vs. 29% at 6 months vs. 26 at 12 months vs. 22% at 24 months; LV end-diastolic diameter 85 mm before CRT vs. 88 mm at 6 months vs. 85 mm at 12 months vs. 84 mm at 24 months).Conclusion:
The temporal relation between cardiomyopathy and LBBB could be a determinant for CRT response. Cardiovascular magnetic resonance tissue tracking may be a useful tool to identify the chronological order and a principal consideration for selecting candidates for CRT. Larger prospective clinical
trials are needed to study the prevalence of, time course of, and risk factors for LBBB-induced cardiomyopathy.
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Affiliation(s)
- Sanshuai Chang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Yi He
- Department of Radiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Fei Guo
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Junping Kang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Xiaohui Liu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China
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Abstract
CRT is a cornerstone of therapy for patients with heart failure and reduced ejection fraction. By restoring left ventricular (LV) electrical and mechanical synchrony, CRT can reduce mortality, improve LV function and reduce heart failure symptoms. Since its introduction, many advances have been made that have improved the delivery of and enhanced the response to CRT. Improving CRT outcomes begins with proper patient selection so CRT is delivered to all populations that could benefit from it, and limiting the implantation of CRT in those with a small chance of response. In addition, advancements in LV leads and delivery technologies coupled with multimodality imaging and electrical mapping have enabled operators to place coronary sinus leads in locations that will optimise electrical and mechanical synchrony. Finally, new pacing strategies using LV endocardial pacing or His bundle pacing have allowed for CRT delivery and improved response in patients with poor coronary sinus anatomy or lack of response to traditional CRT.
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Affiliation(s)
- George Thomas
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
| | - Jiwon Kim
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
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10
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Fujii A, Inden Y, Yanagisawa S, Mamiya K, Okamoto H, Sakamoto Y, Tomomatsu T, Shibata R, Murohara T. Discontinuous contraction in the left ventricle assessed by 2‐D speckle tracking echocardiography benefits from CRT. Pacing Clin Electrophysiol 2019; 42:1204-1212. [DOI: 10.1111/pace.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/22/2019] [Accepted: 07/07/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Aya Fujii
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Yasuya Inden
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | | | - Keita Mamiya
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Hiroya Okamoto
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Yusuke Sakamoto
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Toshiro Tomomatsu
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics Nagoya Japan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
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11
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Kashtanova SY, Mironova NA, Gupalo EM, Gaman SA, Malkina TA, Tarasovskiy GS, Slobodyanik VV, Saidova MA, Golitsyn SP. [Assessment of myocardial electrical dissynchrony by noninvasive activation mapping and its role in achieving the success of cardiac resynchronization]. ACTA ACUST UNITED AC 2019; 59:21-32. [PMID: 31131757 DOI: 10.18087/cardio.2613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess and to compare the ventricular myocardium activation patern obtained by non-invasive epi- and endocardial mapping (NIEEM), as well as electrocardiographic (ECG) variants of lef bundle branch block (LBBB) and to estimate the value of these data for the success of cardiac resynchronization therapy (CRT). MATERIALS AND METHODS Te study included 23 patients (mean age 59,6±9,9 years) with LBBB, QRS duration ≥ 130 ms, lef ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 month. All patients had undergone CRT-D implantation. Depending on presence or absence of LBBB ECG-criteria, proposed by Strauss D.G. et. al, patients were divided into 2 groups: 1group - strict LBBB, proposed by Strauss D.G. et. al. (n=14) and 2 group - other ECG morphologies of LBBB (n=9). NIEEM by the Amycard 01C system with an analysis of epi- and endocardial ventricular electrical activation was performed in all patients and 5 healthy volunteers (mean age 29±1,0years). Response to CRT was estimated by echo and was defned as decrease in lef ventricular (LV) end-systolic volume by > 15% afer 6 months of follow-up. RESULTS LBBB ECG-criteria, proposed by Strauss D.G. et. al, was detected in 14 patients (61% of all included). According to the results of NIEEM, these patients had more pronounced ventricular electrical uncoupling (VEU) (р=0,002). Most ofen the line of block was detected in the anteroseptal or posterolateral region of the LV. Te zone of late LV activation, which is the most optimal position for the LV pacing electrode, was located in the basal and middle segments of the lateral and posterior walls. Afer 6 months of CRT 15 patients (65%) were included in the "response" group, the remaining 8 patients (35%) formed the "non-response" group according to echo criteria. In the "response" group the morphology of the QRS complex more frequently met the criteria, proposed by Strauss D.G. et al, than other ECG variants of LBBB (12 vs. 3 respectively, p = 0.023). Initially, VEU was more pronounced in the "response" group (VEU 55 [51, 64] ms in the "response" group vs 22 [8, 38] ms in the "non-response" group).Сonclusions. LBBB ECG criteria, proposed by Strauss D.G., identify patients with delayed transseptal interventricular conduction due to complete LBBB, what is a good target for CPT. Identifcation of individual ventricular activation properties may help to reveal responders to CRT in patients with LBBB.
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Affiliation(s)
- S Yu Kashtanova
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - N A Mironova
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - E M Gupalo
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - S A Gaman
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - T A Malkina
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - G S Tarasovskiy
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - V V Slobodyanik
- Federal State Budgetary Institution "Academician V. I. Shumakov Federal Research Center of Transplantology and Artifcial Organs" of the Ministry of Health of the Russian Federation
| | - M A Saidova
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - S P Golitsyn
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
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12
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Loring Z, Atwater BD, Xia X, Axelsson J, Klem I, Nijveldt R, Schelbert EB, Couderc JP, Strauss DG, Ugander M, Wieslander B. Low lead one ratio predicts clinical outcomes in left bundle branch block. J Cardiovasc Electrophysiol 2019; 30:709-716. [PMID: 30740823 DOI: 10.1111/jce.13875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/02/2019] [Accepted: 02/06/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We evaluated the association between a novel electrocardiographic (ECG) marker of late, rightward electrocardiographic forces (termed the lead one ratio [LOR]), and left ventricular ejection fraction (LVEF), myocardial scar, and clinical outcomes in patients with left bundle branch block (LBBB). METHODS AND RESULTS LOR was calculated in patients with LBBB from a derivation cohort (n = 240) and receiver operator characteristic curves identified optimal threshold values for predicting myocardial scar and LVEF less than 35%. An independent validation cohort of patients with LBBB (n = 196) was used to test the association of LOR with the myocardial scar, LVEF, and the likelihood of death, heart transplant or left ventricular assist device (LVAD) implantation. The optimal thresholds in the derivation cohort were LOR less than 13.7 for identification of scar (sensitivity 55%, specificity 80%), and LOR less than 12.1 for LVEF less than 35% (sensitivity 49%, specificity 80%). In the validation cohort, LOR less than 13.7 was not associated with scar size or presence (P > 0.05 for both). LOR less than 12.1 was associated with lower LVEF (30 [20-40] versus 40 [25-55]%; P = 0.002) and predicted LVEF less than 35% in univariable (odds ratio [OR], 2.2 [1.2-4.1]; P = 0.01) and multivariable analysis (OR, 2.2 [1.2-4.3]; P = 0.02). LOR less than 12.1 was associated with scar presence when patients with nonischemic cardiomyopathy were excluded (OR = 7.2 [1.5-33.2]; P = 0.002). LOR less than 12.1 had an adjusted hazard ratio of 1.53 ([1.05-2.21]; P = 0.03) for death, transplant or LVAD implantation. CONCLUSIONS In conclusion, ECG LOR less than 12.1 predicts reduced-LV systolic function and poorer prognosis in patients with LBBB.
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Affiliation(s)
- Zak Loring
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Department of Health Services, University of Washington, Seattle, Washington
| | - Brett D Atwater
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Department of Health Services, University of Washington, Seattle, Washington
| | - Xiaojuan Xia
- Department of Health Services, University of Washington, Seattle, Washington.,Cardiology Department, Heart Research Follow-Up Program, University of Rochester, New York
| | - Jimmy Axelsson
- Department of Health Services, University of Washington, Seattle, Washington.,Department of Clinical Physiology, Karolinska Institute, and Karolinska University Hospital, Stockholm, Sweden
| | - Igor Klem
- Department of Health Services, University of Washington, Seattle, Washington
| | - Robin Nijveldt
- Department of Health Services, University of Washington, Seattle, Washington.,Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik B Schelbert
- Department of Health Services, University of Washington, Seattle, Washington.,Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jean-Philippe Couderc
- Department of Health Services, University of Washington, Seattle, Washington.,Cardiology Department, Heart Research Follow-Up Program, University of Rochester, New York
| | - David G Strauss
- Department of Health Services, University of Washington, Seattle, Washington.,Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Martin Ugander
- Department of Health Services, University of Washington, Seattle, Washington.,Department of Clinical Physiology, Karolinska Institute, and Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wieslander
- Department of Health Services, University of Washington, Seattle, Washington.,Cardiology Department, Heart Research Follow-Up Program, University of Rochester, New York.,Department of Clinical Physiology, Karolinska Institute, and Karolinska University Hospital, Stockholm, Sweden
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13
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Tao N, Qiu Y, Tang H, Qian Z, Wu H, Zhu R, Wang Y, Hou X, Zhou W, Zou J. Assessment of left ventricular contraction patterns using gated SPECT MPI to predict cardiac resynchronization therapy response. J Nucl Cardiol 2018; 25:2029-2038. [PMID: 28608184 DOI: 10.1007/s12350-017-0949-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/24/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The U-shaped left ventricular (LV) contraction pattern, identified by MRI or echocardiography, is associated with improved CRT response. Gated SPECT MPI can measure both myocardial viability and mechanical dyssynchrony in a single scan. The aim of this study is to examine the relationship of the LV contraction pattern and the response of CRT in patients with left bundle branch block (LBBB). METHODS Fifty-eight patients who met CRT guidelines and who had pre-CRT MPI were enrolled. Myocardial segments with tracer uptake < 50% of maximum were considered as scar. The LV contraction pattern was considered as U-shaped or non-U-shaped (U-shaped has a block line in the direction of contraction propagation). CRT response was defined as an increase in left ventricular ejection fraction ≥ 5% after 6-month follow-up. RESULTS Twenty-eight patients (48%) had a U-shaped contraction pattern and thirty patients (52%) had a non-U-shaped contraction pattern. The U-shaped group showed a significantly higher response rate than the non-U-shaped group (90% vs. 57%; P = 0.005). By univariate and multivariate logistic regression analysis, the U-shaped pattern was an independent predictor of CRT response. CONCLUSION Non-invasive gated SPECT MPI can characterize LV mechanical contraction patterns. A U-shaped contraction pattern identified is associated with improved CRT response. This may prove useful for improved patient selection for CRT.
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Affiliation(s)
- Ningchao Tao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Yuanhao Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Haipeng Tang
- School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Hongping Wu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Rui Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA.
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China.
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14
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AlJaroudi W. Mechanical dyssynchrony with phase analysis of gated SPECT: Nap time is over. J Nucl Cardiol 2018; 25:2039-2043. [PMID: 28589379 DOI: 10.1007/s12350-017-0951-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
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15
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Zweerink A, Friedman DJ, Klem I, van de Ven PM, Vink C, Biesbroek PS, Hansen SM, Emerek K, Kim RJ, van Rossum AC, Atwater BD, Nijveldt R, Allaart CP. Size Matters. Circ Arrhythm Electrophysiol 2018; 11:e006767. [DOI: 10.1161/circep.118.006767] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| | - Daniel J. Friedman
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
| | - Igor Klem
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands (P.M.v.d.V.)
| | - Caitlin Vink
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| | - P. Stefan Biesbroek
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| | - Steen M. Hansen
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark (S.M.H.)
| | - Kasper Emerek
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
- Department of Clinical Medicine, Aalborg University Hospital, Denmark (K.E.)
| | - Raymond J. Kim
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| | - Brett D. Atwater
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (R.N.)
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
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16
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Masè M, Merlo M, Vitrella G, Stolfo D, Sinagra G. Left ventricular reverse remodeling prediction in non-ischemic cardiomyopathy: present and perspectives. Expert Rev Cardiovasc Ther 2018; 16:771-773. [PMID: 30295546 DOI: 10.1080/14779072.2018.1533815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marco Masè
- a Cardiovascular Department , Azienda Sanitaria-Universitaria Integrata of Trieste (ASUITS) , Trieste , Italy
| | - Marco Merlo
- a Cardiovascular Department , Azienda Sanitaria-Universitaria Integrata of Trieste (ASUITS) , Trieste , Italy
| | - Giancarlo Vitrella
- a Cardiovascular Department , Azienda Sanitaria-Universitaria Integrata of Trieste (ASUITS) , Trieste , Italy
| | - Davide Stolfo
- a Cardiovascular Department , Azienda Sanitaria-Universitaria Integrata of Trieste (ASUITS) , Trieste , Italy
| | - Gianfranco Sinagra
- a Cardiovascular Department , Azienda Sanitaria-Universitaria Integrata of Trieste (ASUITS) , Trieste , Italy
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17
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Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
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18
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Sengupta PP, Kramer CM, Narula J, Dilsizian V. The Potential of Clinical Phenotyping of Heart Failure With Imaging Biomarkers for Guiding Therapies: A Focused Update. JACC Cardiovasc Imaging 2018; 10:1056-1071. [PMID: 28882290 DOI: 10.1016/j.jcmg.2017.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
The need for noninvasive assessment of cardiac volumes and ejection fraction (EF) ushered in the use of cardiac imaging techniques in heart failure (HF) trials that investigated the roles of pharmacological and device-based therapies. However, in contrast to HF with reduced EF (HFrEF), modern HF pharmacotherapy has not improved outcomes in HF with preserved EF (HFpEF), largely attributed to patient heterogeneity and incomplete understanding of pathophysiological insights underlying the clinical presentations of HFpEF. Modern cardiac imaging methods offer insights into many sets of changes in cardiac tissue structure and function that can precisely link cause with cardiac remodeling at organ and tissue levels to clinical presentations in HF. This has inspired investigators to seek a more comprehensive understanding of HF presentations using imaging techniques. This article summarizes the available evidence regarding the role of cardiac imaging in HF. Furthermore, we discuss the value of cardiac imaging techniques in identifying HF patient subtypes who share similar causes and mechanistic pathways that can be targeted using specific HF therapies.
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Affiliation(s)
- Partho P Sengupta
- Section of Cardiology, West Virginia University Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia.
| | - Christopher M Kramer
- Departments of Medicine and Radiology and Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Jagat Narula
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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19
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Martens P, Nijst P, Verbrugge FH, Dupont M, Tang WW, Mullens W. Profound differences in prognostic impact of left ventricular reverse remodeling after cardiac resynchronization therapy relate to heart failure etiology. Heart Rhythm 2018; 15:130-136. [DOI: 10.1016/j.hrthm.2017.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 11/25/2022]
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20
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Steinmetz M, Usenbenz S, Kowallick JT, Hösch O, Staab W, Lange T, Kutty S, Lotz J, Hasenfuß G, Paul T, Schuster A. Left ventricular synchrony, torsion, and recoil mechanics in Ebstein's anomaly: insights from cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:101. [PMID: 29237468 PMCID: PMC5729283 DOI: 10.1186/s12968-017-0414-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/23/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Disease progression and heart failure development in Ebstein's Anomaly (EA) of the tricuspid valve is characterized by both right and left ventricular (LV) deterioration. The mechanisms underlying LV dysfunction and their role in heart failure development are incompletely understood. We hypothesized that LV dyssynchrony and impaired torsion and recoil mechanics induced by paradoxical movement of the basal septum may play a role in heart failure development. METHODS 31 EA patients and 31 matched controls underwent prospective cardiovascular magnetic resonance (CMR). CMR feature tracking (CMR-FT) was performed on apical, midventricular and basal short-axis and 4D-volume analysis was performed using three long-axis views and a short axis cine stack employing dedicated software. Circumferential uniformity ratio estimates (CURE) time-to-peak-based circumferential systolic dyssynchrony index (C-SDI), 4D volume analysis derived SDI (4D-SDI), torsion (Tor) and systolic (sysTR) and diastolic torsion rate (diasTR) were calculated for the LV. QRS duration, brain natriuretic peptide, NYHA and Total R/L-Volume Index (R/L Index) were obtained. RESULTS EA patients (31.5 years; controls 31.4 years) had significantly longer QRS duration (123.35 ms ± 26.36 vs. 97.33 ms ± 11.89 p < 0.01) and showed more LV dyssynchrony (4D-SDI 7.60% ± 4.58 vs. 2.54% ± 0.62, p < 0.001; CURE 0.77 ± 0.05 vs. 0.86 ± 0.03, p < 0.001; C-SDI 7.70 ± 3.38 vs. 3.80 ± 0.91, p = 0.001). There were significant associations of LV dyssynchrony with heart failure parameters and QRS duration. Although torsion and recoil mechanics did not differ significantly (p > 0.05) there was an association of torsion and recoil mechanics with dyssynchrony parameters CURE (sysTR r = -0.426; p = 0.017, diasTR r = 0.419; p = 0.019), 4D-SDI (sysTR r = 0.383; p = 0.044) and C-SDI (diasTR r = -0.364; p = 0.044). CONCLUSIONS EA is characterized by LV intra-ventricular dyssynchrony, which is associated with heart failure and disease severity parameters. Markers of dyssynchrony can easily be quantified from CMR-FT, and may have a role in the assessment of altered cardiac function, carrying potential management implications for EA patients.
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Affiliation(s)
- Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Simon Usenbenz
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Johannes Tammo Kowallick
- Institute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Olga Hösch
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Göttingen, Germany
| | - Wieland Staab
- Institute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Götttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- University of Nebraska Medical Center/ Children’s Hospital and Medical Center, Omaha, NE USA
| | - Joachim Lotz
- Institute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Götttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Götttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
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21
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Kanawati J, Sy RW. Contemporary Review of Left Bundle Branch Block in the Failing Heart - Pathogenesis, Prognosis, and Therapy. Heart Lung Circ 2017; 27:291-300. [PMID: 29097067 DOI: 10.1016/j.hlc.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/13/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
Cardiac resynchronisation therapy (CRT) is a cornerstone in the contemporary management of heart failure. The most effective way of predicting response to this therapy remains electrocardiographic (ECG) criteria of electromechanical dyssynchrony. The left bundle branch block (LBBB) pattern is currently the most robust ECG criterion in predicting improvement in symptoms and reduction in mortality. However, recent studies using three-dimensional (3D) mapping and cardiac magnetic resonance imaging (CMR) have demonstrated heterogeneous left ventricular activation patterns in patients with LBBB. This has led to intense debate on the activation pattern of "true LBBB" and resulted in the proposal of stricter criteria for defining LBBB. This review will focus on the definitions and implications of LBBB in the CRT era. At a minimum, the use of stricter ECG criteria appears warranted, and adjunctive pre-implant imaging or mapping may further identify patient-specific electrophysiological patterns that determine response to CRT.
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Affiliation(s)
- Juliana Kanawati
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Raymond W Sy
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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22
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Kowallick JT, Morton G, Lamata P, Jogiya R, Kutty S, Hasenfuß G, Lotz J, Chiribiri A, Nagel E, Schuster A. Quantitative assessment of left ventricular mechanical dyssynchrony using cine cardiovascular magnetic resonance imaging: Inter-study reproducibility. JRSM Cardiovasc Dis 2017; 6:2048004017710142. [PMID: 28567282 PMCID: PMC5438106 DOI: 10.1177/2048004017710142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/13/2017] [Accepted: 04/23/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the inter-study reproducibility of left ventricular (LV) mechanical dyssynchrony measures based on standard cardiovascular magnetic resonance (CMR) cine images. DESIGN Steady-state free precession (SSFP) LV short-axis stacks and three long-axes were acquired on the same day at three time points. Circumferential strain systolic dyssynchrony indexes (SDI), area-SDI as well as circumferential and radial uniformity ratio estimates (CURE and RURE, respectively) were derived from CMR myocardial feature-tracking (CMR-FT) based on the tracking of three SSFP short-axis planes. Furthermore, 4D-LV-analysis based on SSFP short-axis stacks and longitudinal planes was performed to quantify 4D-volume-SDI. SETTING A single-centre London teaching hospital. PARTICIPANTS 16 healthy volunteers. MAIN OUTCOME MEASURES Inter-study reproducibility between the repeated exams. RESULTS CURE and RURE as well as 4D-volume-SDI showed good inter-study reproducibility (coefficient of variation [CoV] 6.4%-12.9%). Circumferential strain and area-SDI showed higher variability between the repeated measurements (CoV 24.9%-37.5%). Uniformity ratio estimates showed the lowest inter-study variability (CoV 6.4%-8.5%). CONCLUSIONS Derivation of LV mechanical dyssynchrony measures from standard cine images is feasible using CMR-FT and 4D-LV-analysis tools. Uniformity ratio estimates and 4D-volume-SDI showed good inter-study reproducibility. Their clinical value should next be explored in patients who potentially benefit from cardiac resynchronization therapy.
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Affiliation(s)
- Johannes T Kowallick
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | | | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Roy Jogiya
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Gerd Hasenfuß
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,Division of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research (DZHK, partner site Rhine-Main), Frankfurt, Germany
| | - Andreas Schuster
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
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23
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Behar JM, Mountney P, Toth D, Reiml S, Panayiotou M, Brost A, Fahn B, Karim R, Claridge S, Jackson T, Sieniewicz B, Patel N, O'Neill M, Razavi R, Rhode K, Rinaldi CA. Real-Time X-MRI-Guided Left Ventricular Lead Implantation for Targeted Delivery of Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2017; 3:803-814. [PMID: 29759775 DOI: 10.1016/j.jacep.2017.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to test the feasibility of a purpose-built, integrated software platform to process, analyze, and overlay cardiac magnetic resonance (CMR) data in real time within a combined cardiac catheter laboratory and magnetic resonance imaging scanner suite (X-MRI) to guide left ventricular (LV) lead implantation. BACKGROUND Suboptimal LV lead position is a major determinant of poor cardiac resynchronization therapy (CRT) response, and the optimal site is highly patient specific. Pacing myocardial scar is associated with poorer outcomes; conversely, targeting latest mechanical activation (LMA) may improve them. METHODS Fourteen patients (age 74 ± 5.1 years; New York Heart Association functional class: 2.7 ± 0.4; 86% ischemic with ejection fraction 27 ± 7.6%; QRSd: 157 ± 19 ms) underwent CMR followed by immediate CRT implantation using derived scar and dyssynchrony data, overlaid onto fluoroscopy in an X-MRI suite. Rapid LV segmentation enabled detailed scar quantification, identification of LMA segments, and selection of myocardial targets. At coronary venography, the CMR-derived 3-dimensional shell was fused, enabling identification of viable venous targets subtended by target segments for LV lead placement. RESULTS The platform was successful in all 14 patients, of whom 10 (71%) were paced in pre-procedurally defined target segments. Pacing in CMR-defined target segments (out of scar) showed a significant decrease in the LV capture threshold (mean difference: 2.4 [1.5 to 3.2]; p < 0.001) and shorter paced QRS duration (mean difference: 25 [15 to 34]; p < 0.001) compared with pacing in areas of CMR determined scar. In 5 (36%) patients with extensive scar in the posterolateral wall, CMR guidance enabled successful lead delivery in an alternative anatomically favorable site. Radiation dose and implant times were similar to historical controls (p = NS). CONCLUSIONS Real-time CMR-guided LV lead placement is feasible and achievable in a single clinical setting and may prove helpful to preferentially select sites for LV lead placement.
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Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom.
| | - Peter Mountney
- Medical Imaging Technologies, Siemens Healthineers, Princeton, New Jersey
| | - Daniel Toth
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom; Siemens Healthineers, Frimley, Camberley, United Kingdom
| | | | - Maria Panayiotou
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | | | | | - Rashed Karim
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Simon Claridge
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Ben Sieniewicz
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Nik Patel
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Mark O'Neill
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Kawal Rhode
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Christopher Aldo Rinaldi
- Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom
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Panayiotou M, Mountney P, Brost A, Toth D, Jackson T, Behar JM, Rinaldi CA, Housden RJ, Rhode KS. Dynamic mapping of ventricular function from cardiovascular magnetic resonance imaging. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4137-4140. [PMID: 28269193 DOI: 10.1109/embc.2016.7591637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Heart failure is associated with substantial mortality and morbidity and remains the most common diagnosis in older patients. Based on experimental electrophysiologic studies, cardiac resynchronization therapy (CRT) for heart failure results in a maximum resynchronization effect when applied to the most delayed left ventricular (LV) site. Current clinical practice is to identify the optimal site using separate visualisation of scar and activation information. These must be mentally mapped into 3D, which is challenging and time-consuming for the electrophysiologist. The aim of this work is to improve patient planning for CRT by mapping propagation of mechanical activation from cardiac magnetic resonance (CMR) onto a three-dimensional plus time (3D+t) model map to assist the cardiologist in determining the optimal LV pacing site. Automatic motion analysis of the 16-segment patient-specific LV anatomical model, automatically segmented from cine MR data, was done and regional volume change curves as a function of the cardiac cycle along with intraventricular dyssynchrony indices were extracted. The regional volume information computed was then mapped onto all phases of the 3D+t CMR data, which provides a 3D+t mechanical activation map over the whole cardiac cycle. This workflow was tested on 7 patients and 3 healthy volunteers. This mapping of the regional change of volume across the LV during ventricular pacing could facilitate the selection of the optimum pacing segment at the planning stage of the procedure, and consequently decrease the number of inadequate responders to CRT.
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25
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Tang H, Tang S, Zhou W. A Review of Image-guided Approaches for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2017; 6:69-74. [PMID: 28845234 DOI: 10.15420/aer.2016.32.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) is a standard treatment for patients with heart failure; however, the low response rate significantly reduces its cost-effectiveness. A favourable CRT response primarily depends on whether implanters can identify the optimal left ventricular (LV) lead position and accurately place the lead at the recommended site. Myocardial imaging techniques, including echocardiography, cardiac magnetic resonance imaging and nuclear imaging, have been used to assess LV myocardial viability and mechanical dyssynchrony, and deduce the optimal LV lead position. The optimal position, presented as a segment of the myocardial wall, is then overlaid with images of the coronary veins from fluoroscopy to aid navigation of the LV lead to the target venous site. Once validated by large clinical trials, these image-guided techniques for CRT lead placement may have an impact on current clinical practice.
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Affiliation(s)
- Haipeng Tang
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
| | - Shaojie Tang
- School of Automation, Xi'an University of Posts and Telecommunications, Xi'an, Shaanxi, China
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
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26
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Cardiovascular magnetic resonance features of mechanical dyssynchrony in patients with left bundle branch block. Int J Cardiovasc Imaging 2016; 32:1427-1438. [PMID: 27306621 DOI: 10.1007/s10554-016-0925-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Patients with left bundle branch block (LBBB) can exhibit mechanical dyssynchrony which may contribute to heart failure; such patients may benefit from cardiac resynchronization treatment (CRT). While cardiac magnetic resonance imaging (CMR) has become a common part of heart failure work-up, CMR features of mechanical dyssynchrony in patients with LBBB have not been well characterized. This study aims to investigate the potential of CMR to characterize mechanical features of LBBB. CMR examinations from 43 patients with LBBB on their electrocardiogram, but without significant focal structural abnormalities, and from 43 age- and gender-matched normal controls were retrospectively reviewed. The following mechanical features of LBBB were evaluated: septal flash (SF), apical rocking (AR), delayed aortic valve opening measured relative to both end-diastole (AVOED) and pulmonic valve opening (AVOPVO), delayed left-ventricular (LV) free-wall contraction, and curvatures of the septum and LV free-wall. Septal displacement curves were also generated, using feature-tracking techniques. The echocardiographic findings of LBBB were also reviewed in those subjects for whom they were available. LBBB was significantly associated with the presence of SF and AR; within the LBBB group, 79 % had SF and 65 % had AR. Delayed AVOED, AVOPVO, and delayed LV free-wall contraction were significantly associated with LBBB. AVOED and AVOPVO positively correlated with QRS duration and negatively correlated with ejection fraction. Hearts with electrocardiographic evidence of LBBB showed lower septal-to-LV free-wall curvature ratios at end-diastole compared to normal controls. CMR can be used to identify and evaluate mechanical dyssynchrony in patients with LBBB. None of the normal controls showed the mechanical features associated with LBBB. Moreover, not all patients with LBBB showed the same degree of mechanical dyssynchrony, which could have implications for CRT.
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27
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Chen Z, Hanson B, Sohal M, Sammut E, Jackson T, Child N, Claridge S, Behar J, Niederer S, Gill J, Carr-White G, Razavi R, Rinaldi CA, Taggart P. Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and nonresponders to cardiac resynchronization therapy. Heart Rhythm 2016; 13:1898-904. [PMID: 27301781 DOI: 10.1016/j.hrthm.2016.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND The high risk of ventricular arrhythmias in patients with heart failure remains despite the benefit of cardiac resynchronization therapy (CRT). An electromechanical interaction between regional myocardial strain patterns and the electrophysiological substrate is thought to be important. OBJECTIVE We investigated the in vivo relation between left ventricular activation recovery interval (ARI), as a surrogate measure of action potential duration (APD), and local myocardial strain patterns in responders and nonresponders to CRT. METHODS ARIs were recorded from the left ventricular epicardium in 20 patients with CRT 6 weeks and 6 months post implantation. Two-dimensional speckle tracking echocardiography was performed at the same time to assess myocardial strains. Patients with ≥15% reduction in end-systolic volume at 6 months were classified as responders. RESULTS ARI decreased in responders (263 ± 46 ms vs 246 ± 47 ms, P < .01) and increased in nonresponders (235 ± 23 ms vs 261 ± 20 ms; P < .01). Time-to-peak radial, circumferential, and longitudinal strains increased in responders (41 ± 27, 35 ± 25, 56 ± 37 ms; P < .01) and decreased in nonresponders (-58 ± 26, -47 ± 26, -64 ± 27 ms; P < .01). There was a nonlinear correlation between changes in time-to-peak strain and ARIs (Spearman correlation coefficient r ≥ 0.70; P < .01). Baseline QRS duration >145 ms and QRS duration shortening with biventricular pacing were associated with ARI shortening following CRT. CONCLUSION Changes in ventricular wall mechanics predict local APD lengthening or shortening during CRT. Nonresponders have a worsening of myocardial strain and local APD. Baseline QRS duration >145 ms and QRS duration shortening with biventricular pacing identified patients who exhibited improvement in APD.
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Affiliation(s)
- Zhong Chen
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom,.
| | - Ben Hanson
- University College London, London, United Kingdom
| | - Manav Sohal
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Eva Sammut
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Tom Jackson
- King's College London, London, United Kingdom
| | - Nicholas Child
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Simon Claridge
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jonathan Behar
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | | | - Jaswinder Gill
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Gerald Carr-White
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Reza Razavi
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - C Aldo Rinaldi
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
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28
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Saporito S, van Assen HC, Houthuizen P, Aben JPMM, Strik M, van Middendorp LB, Prinzen FW, Mischi M. Assessment of left ventricular mechanical dyssynchrony in left bundle branch block canine model: Comparison between cine and tagged MRI. J Magn Reson Imaging 2016; 44:956-63. [PMID: 26973138 DOI: 10.1002/jmri.25225] [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: 12/04/2015] [Accepted: 02/23/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare cine and tagged magnetic resonance imaging (MRI) for left ventricular dyssynchrony assessment in left bundle branch block (LBBB), using the time-to-peak contraction timing, and a novel approach based on cross-correlation. MATERIALS AND METHODS We evaluated a canine model dataset (n = 10) before (pre-LBBB) and after induction of isolated LBBB (post-LBBB). Multislice short-axis tagged and cine MRI images were acquired using a 1.5 T scanner. We computed contraction time maps by cross-correlation, based on the timing of radial wall motion and of circumferential strain. Finally, we estimated dyssynchrony as the standard deviation of the contraction time over the different regions of the myocardium. RESULTS Induction of LBBB resulted in a significant increase in dyssynchrony (cine: 13.0 ± 3.9 msec for pre-LBBB, and 26.4 ± 5.0 msec for post-LBBB, P = 0.005; tagged: 17.1 ± 5.0 msec at for pre-LBBB, and 27.9 ± 9.8 msec for post-LBBB, P = 0.007). Dyssynchrony assessed by cine and tagged MRI were in agreement (r = 0.73, P = 0.0003); differences were in the order of time difference between successive frames of 20 msec (bias: -2.9 msec; limit of agreement: 10.1 msec). Contraction time maps were derived; agreement was found in the contraction patterns derived from cine and tagged MRI (mean difference in contraction time per segment: 3.6 ± 13.7 msec). CONCLUSION This study shows that the proposed method is able to quantify dyssynchrony after induced LBBB in an animal model. Cine-assessed dyssynchrony agreed with tagged-derived dyssynchrony, in terms of magnitude and spatial direction. J. MAGN. RESON. IMAGING 2016;44:956-963.
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Affiliation(s)
- Salvatore Saporito
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Hans C van Assen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Marc Strik
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Lars B van Middendorp
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Vaillant F, Magat J, Bour P, Naulin J, Benoist D, Loyer V, Vieillot D, Labrousse L, Ritter P, Bernus O, Dos Santos P, Quesson B. Magnetic resonance-compatible model of isolated working heart from large animal for multimodal assessment of cardiac function, electrophysiology, and metabolism. Am J Physiol Heart Circ Physiol 2016; 310:H1371-80. [PMID: 26968545 DOI: 10.1152/ajpheart.00825.2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/04/2016] [Indexed: 11/22/2022]
Abstract
To provide a model close to the human heart, and to study intrinsic cardiac function at the same time as electromechanical coupling, we developed a magnetic resonance (MR)-compatible setup of isolated working perfused pig hearts. Hearts from pigs (40 kg, n = 20) and sheep (n = 1) were blood perfused ex vivo in the working mode with and without loaded right ventricle (RV), for 80 min. Cardiac function was assessed by measuring left intraventricular pressure and left ventricular (LV) ejection fraction (LVEF), aortic and mitral valve dynamics, and native T1 mapping with MR imaging (1.5 Tesla). Potential myocardial alterations were assessed at the end of ex vivo perfusion from late-Gadolinium enhancement T1 mapping. The ex vivo cardiac function was stable across the 80 min of perfusion. Aortic flow and LV-dP/dtmin were significantly higher (P < 0.05) in hearts perfused with loaded RV, without differences for heart rate, maximal and minimal LV pressure, LV-dP/dtmax, LVEF, and kinetics of aortic and mitral valves. T1 mapping analysis showed a spatially homogeneous distribution over the LV. Simultaneous recording of hemodynamics, LVEF, and local cardiac electrophysiological signals were then successfully performed at baseline and during electrical pacing protocols without inducing alteration of MR images. Finally, (31)P nuclear MR spectroscopy (9.4 T) was also performed in two pig hearts, showing phosphocreatine-to-ATP ratio in accordance with data previously reported in vivo. We demonstrate the feasibility to perfuse isolated pig hearts in the working mode, inside an MR environment, allowing simultaneous assessment of cardiac structure, mechanics, and electrophysiology, illustrating examples of potential applications.
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Affiliation(s)
- Fanny Vaillant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and
| | - Julie Magat
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and
| | - Pierre Bour
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and
| | - Jérôme Naulin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and
| | - David Benoist
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and
| | - Virginie Loyer
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and
| | - Delphine Vieillot
- Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France
| | - Louis Labrousse
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Bordeaux University Hospital (CHU), Cardiothoracic Pole, F-33600 Pessac, France
| | - Philippe Ritter
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Bordeaux University Hospital (CHU), Cardiothoracic Pole, F-33600 Pessac, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and
| | - Pierre Dos Santos
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and Bordeaux University Hospital (CHU), Cardiothoracic Pole, F-33600 Pessac, France
| | - Bruno Quesson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, foundation Bordeaux Université, F-33600 Pessac- Bordeaux, France; Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; and
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Hartlage GR, Suever JD, Clement-Guinaudeau S, Strickland PT, Ghasemzadeh N, Magrath RP, Parikh A, Lerakis S, Hoskins MH, Leon AR, Lloyd MS, Oshinski JN. Prediction of response to cardiac resynchronization therapy using left ventricular pacing lead position and cardiovascular magnetic resonance derived wall motion patterns: a prospective cohort study. J Cardiovasc Magn Reson 2015; 17:57. [PMID: 26170046 PMCID: PMC4501253 DOI: 10.1186/s12968-015-0158-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 06/22/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite marked benefits in many heart failure patients, a considerable proportion of patients treated with cardiac resynchronization therapy (CRT) fail to respond appropriately. Recently, a "U-shaped" (type II) wall motion pattern identified by cardiovascular magnetic resonance (CMR) has been associated with improved CRT response compared to a homogenous (type I) wall motion pattern. There is also evidence that a left ventricular (LV) lead localized to the latest contracting LV site predicts superior response, compared to an LV lead localized remotely from the latest contracting LV site. METHODS We prospectively evaluated patients undergoing CRT with pre-procedural CMR to determine the presence of type I and type II wall motion patterns and pre-procedural echocardiography to determine end systolic volume (ESV). We assessed the final LV lead position on post-procedural fluoroscopic images to determine whether the lead was positioned concordant to or remote from the latest contracting LV site. CRT response was defined as a ≥ 15% reduction in ESV on a 6 month follow-up echocardiogram. RESULTS The study included 33 patients meeting conventional indications for CRT with a mean New York Heart Association class of 2.8 ± 0.4 and mean LV ejection fraction of 28 ± 9%. Overall, 55% of patients were echocardiographic responders by ESV criteria. Patients with both a type II pattern and an LV lead concordant to the latest contracting site (T2CL) had a response rate of 92%, compared to a response rate of 33% for those without T2CL (p = 0.003). T2CL was the only independent predictor of response on multivariate analysis (odds ratio 18, 95% confidence interval 1.6-206; p = 0.018). T2CL resulted in significant incremental improvement in prediction of echocardiographic response (increase in the area under the receiver operator curve from 0.69 to 0.84; p = 0.038). CONCLUSIONS The presence of a type II wall motion pattern on CMR and a concordant LV lead predicts superior CRT response. Improving patient selection by evaluating wall motion pattern and targeting LV lead placement may ultimately improve the response rate to CRT.
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Affiliation(s)
- Gregory R Hartlage
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jonathan D Suever
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA.
| | | | - Patrick T Strickland
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Nima Ghasemzadeh
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - R Patrick Magrath
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA.
| | - Ankit Parikh
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Stamatios Lerakis
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Michael H Hoskins
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Angel R Leon
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Michael S Lloyd
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - John N Oshinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA.
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Seo Y, Ishizu T, Kawamura R, Yamamoto M, Kuroki K, Igarashi M, Sekiguchi Y, Nogami A, Aonuma K. Three-Dimensional Propagation Imaging of Left Ventricular Activation by Speckle-Tracking Echocardiography to Predict Responses to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2015; 28:606-14. [DOI: 10.1016/j.echo.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 11/30/2022]
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Ishibashi K, Kubo T, Kitabata H, Takarada S, Shimamura K, Tanimoto T, Orii M, Shiono Y, Yamano T, Ino Y, Yamaguchi T, Hirata K, Tanaka A, Imanishi T, Akasaka T. Reply to Letter Regarding Article, “Improvement of Cardiac Function by Increasing Stimulus Strength during Left Ventricular Pacing in Cardiac Resynchronization Therapy”. Int Heart J 2015; 56:580. [DOI: 10.1536/ihj.15-262] [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: 11/18/2022]
Affiliation(s)
- Kohei Ishibashi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Shigeho Takarada
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kumiko Hirata
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
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Prakosa A, Sermesant M, Allain P, Villain N, Rinaldi CA, Rhode K, Razavi R, Delingette H, Ayache N. Cardiac electrophysiological activation pattern estimation from images using a patient-specific database of synthetic image sequences. IEEE Trans Biomed Eng 2014; 61:235-45. [PMID: 24058008 DOI: 10.1109/tbme.2013.2281619] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While abnormal patterns of cardiac electrophysiological activation are at the origin of important cardiovascular diseases (e.g., arrhythmia, asynchrony), the only clinically available method to observe detailed left ventricular endocardial surface activation pattern is through invasive catheter mapping. However, this electrophysiological activation controls the onset of the mechanical contraction; therefore, important information about the electrophysiology could be deduced from the detailed observation of the resulting motion patterns. In this paper, we present the study of this inverse cardiac electrokinematic relationship. The objective is to predict the activation pattern knowing the cardiac motion from the analysis of cardiac image sequences. To achieve this, we propose to create a rich patient-specific database of synthetic time series of the cardiac images using simulations of a personalized cardiac electromechanical model, in order to study this complex relationship between electrical activity and kinematic patterns in the context of this specific patient. We use this database to train a machine-learning algorithm which estimates the depolarization times of each cardiac segment from global and regional kinematic descriptors based on displacements or strains and their derivatives. Finally, we use this learning to estimate the patient’s electrical activation times using the acquired clinical images. Experiments on the inverse electrokinematic learning are demonstrated on synthetic sequences and are evaluated on clinical data with promising results. The error calculated between our prediction and the invasive intracardiac mapping ground truth is relatively small (around 10 ms for ischemic patients and 20 ms for nonischemic patient). This approach suggests the possibility of noninvasive electrophysiological pattern estimation using cardiac motion imaging.
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Sohal M, Amraoui S, Chen Z, Sammut E, Jackson T, Wright M, O’Neill M, Gill J, Carr-White G, Rinaldi CA, Razavi R. Combined identification of septal flash and absence of myocardial scar by cardiac magnetic resonance imaging improves prediction of response to cardiac resynchronization therapy. J Interv Card Electrophysiol 2014; 40:179-90. [DOI: 10.1007/s10840-014-9907-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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Jackson T, Sohal M, Chen Z, Child N, Sammut E, Behar J, Claridge S, Carr-White G, Razavi R, Rinaldi CA. A U-shaped type II contraction pattern in patients with strict left bundle branch block predicts super-response to cardiac resynchronization therapy. Heart Rhythm 2014; 11:1790-7. [PMID: 24912138 DOI: 10.1016/j.hrthm.2014.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND New criteria to define strict left bundle branch block (LBBB) on the basis of pathophysiological principles predict response to cardiac resynchronization therapy (CRT). Heterogeneous activation and contraction patterns have been identified in patients with classical LBBB. Cardiac magnetic resonance (CMR) imaging has demonstrated that a U-shaped (type II) contraction predicts reverse remodeling post-CRT. A homogeneous spread of (type I) contraction is less predictive. OBJECTIVES The purpose of this study was to investigate contraction patterns among patients with strict LBBB and to test whether a type II contraction pattern better predicts CRT response and super-response. METHODS Thirty-seven patients with strict LBBB (QRS duration ≥140 ms for men and ≥130 ms for women with mid-QRS notching or slurring in ≥2 contiguous leads) underwent cine CMR imaging pre-CRT with an analysis of their contraction patterns by using endocardial contour tracking software. Patients were evaluated for reverse remodeling 6 months postimplantation. RESULTS Nineteen patients (51%) had a type II contraction pattern. A total of 25 patients (68%) of the cohort reverse remodeled. In the type II contraction group, all 19 patients (100%) reverse remodeled as compared with 6 patients (33%) in the type I contraction group (P < .01). Super-response was achieved in 21 patients (57%) of the total cohort: 5 patients with a type I contraction pattern (28%) and 16 patients with a type II contraction pattern (84%) (P < .01). CONCLUSION Patients with strict LBBB who are guideline indicated for CRT have heterogeneous contraction patterns derived from cine CMR. A type II contraction pattern is strongly predictive for reverse remodeling and super-response. This questions whether strict LBBB criteria alone are sufficient to reliably predict a positive response to CRT.
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Affiliation(s)
- Tom Jackson
- King's College London, London, United Kingdom.
| | - Manav Sohal
- King's College London, London, United Kingdom
| | - Zhong Chen
- King's College London, London, United Kingdom
| | | | - Eva Sammut
- King's College London, London, United Kingdom
| | | | | | | | - Reza Razavi
- King's College London, London, United Kingdom
| | - Christopher Aldo Rinaldi
- King's College London, London, United Kingdom; Guy's and St. Thomas' Hospitals, London, United Kingdom
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Prinzen FW, Kroon W, Auricchio A. U-shaped mechanical activation 4 U? JACC. CARDIOVASCULAR IMAGING 2013; 6:874-6. [PMID: 23948378 DOI: 10.1016/j.jcmg.2012.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/06/2012] [Indexed: 11/29/2022]
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Sengupta PP, Kramer CM, Narula J. Cardiac Resynchronization: The Flow of Activation Sequence. JACC Cardiovasc Imaging 2013; 6:924-6. [DOI: 10.1016/j.jcmg.2013.07.002] [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: 10/26/2022]
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Noninvasive Assessment of Myocardial Dyssynchrony Prior to Cardiac Resynchronization Therapy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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