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Stankovic I, Voigt JU, Burri H, Muraru D, Sade LE, Haugaa KH, Lumens J, Biffi M, Dacher JN, Marsan NA, Bakelants E, Manisty C, Dweck MR, Smiseth OA, Donal E. Imaging in patients with cardiovascular implantable electronic devices: part 1-imaging before and during device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J Cardiovasc Imaging 2023; 25:e1-e32. [PMID: 37861372 DOI: 10.1093/ehjci/jead272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
More than 500 000 cardiovascular implantable electronic devices (CIEDs) are implanted in the European Society of Cardiology countries each year. The role of cardiovascular imaging in patients being considered for CIED is distinctly different from imaging in CIED recipients. In the former group, imaging can help identify specific or potentially reversible causes of heart block, the underlying tissue characteristics associated with malignant arrhythmias, and the mechanical consequences of conduction delays and can also aid challenging lead placements. On the other hand, cardiovascular imaging is required in CIED recipients for standard indications and to assess the response to device implantation, to diagnose immediate and delayed complications after implantation, and to guide device optimization. The present clinical consensus statement (Part 1) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients undergoing implantation of conventional pacemakers, cardioverter defibrillators, and resynchronization therapy devices. The document summarizes the existing evidence regarding the use of imaging in patient selection and during the implantation procedure and also underlines gaps in evidence in the field. The role of imaging after CIED implantation is discussed in the second document (Part 2).
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Affiliation(s)
- Ivan Stankovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Faculty of Medicine, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven/Department of Cardiovascular Sciences, Catholic University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- Department of Cardiology, University of Baskent, Ankara, Turkey
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine Karolinska Institutet AND Cardiovascular Division, Karolinska University Hospital, StockholmSweden
| | - Joost Lumens
- Cardiovascular Research Center Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, F 76000 Rouen, France
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Elise Bakelants
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
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2
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Manganaro R, Cusmà-Piccione M, Carerj S, Licordari R, Khandheria BK, Zito C. Echocardiographic Patterns of Abnormal Septal Motion: Beyond Myocardial Ischemia. J Am Soc Echocardiogr 2023; 36:1140-1153. [PMID: 37574150 DOI: 10.1016/j.echo.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
Abnormal septal motion (ASM), which often is associated with myocardial ischemia, is also observed in other diseases. Owing to the position of the interventricular septum (IVS) in the heart, its movement not only relies on contractile properties but is also affected by the pressure gradient between the 2 ventricles and by the mode of electrical activation. Echocardiography allows the operator to focus on the motion of the IVS, analyzing its characteristics and thereby gaining information about the possible underlying pathophysiological mechanism. In this review, we focused on the main echocardiographic patterns of ASM that are not related to a failure of contractile properties of the septum (i.e., acute coronary syndrome and cardiomyopathies), showing their pathophysiological mechanisms and underlining their diagnostic usefulness in clinical practice.
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Affiliation(s)
- Roberta Manganaro
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Maurizio Cusmà-Piccione
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, Wisconsin
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
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Duchenne J, Larsen CK, Cvijic M, Galli E, Aalen JM, Klop B, Mirea O, Puvrez A, Bézy S, Wouters L, Minten L, Sirnes PA, Khan FH, Voros G, Willems R, Penicka M, Kongsgård E, Hopp E, Bogaert J, Smiseth OA, Donal E, Voigt JU. Mechanical Dyssynchrony Combined with Septal Scarring Reliably Identifies Responders to Cardiac Resynchronization Therapy. J Clin Med 2023; 12:6108. [PMID: 37763048 PMCID: PMC10531814 DOI: 10.3390/jcm12186108] [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: 07/31/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Background and aim: The presence of mechanical dyssynchrony on echocardiography is associated with reverse remodelling and decreased mortality after cardiac resynchronization therapy (CRT). Contrarily, myocardial scar reduces the effect of CRT. This study investigated how well a combined assessment of different markers of mechanical dyssynchrony and scarring identifies CRT responders. Methods: In a prospective multicentre study of 170 CRT recipients, septal flash (SF), apical rocking (ApRock), systolic stretch index (SSI), and lateral-to-septal (LW-S) work differences were assessed using echocardiography. Myocardial scarring was quantified using cardiac magnetic resonance imaging (CMR) or excluded based on a coronary angiogram and clinical history. The primary endpoint was a CRT response, defined as a ≥15% reduction in LV end-systolic volume 12 months after implantation. The secondary endpoint was time-to-death. Results: The combined assessment of mechanical dyssynchrony and septal scarring showed AUCs ranging between 0.81 (95%CI: 0.74-0.88) and 0.86 (95%CI: 0.79-0.91) for predicting a CRT response, without significant differences between the markers, but significantly higher than mechanical dyssynchrony alone. QRS morphology, QRS duration, and LV ejection fraction were not superior in their prediction. Predictive power was similar in the subgroups of patients with ischemic cardiomyopathy. The combined assessments significantly predicted all-cause mortality at 44 ± 13 months after CRT with a hazard ratio ranging from 0.28 (95%CI: 0.12-0.67) to 0.20 (95%CI: 0.08-0.49). Conclusions: The combined assessment of mechanical dyssynchrony and septal scarring identified CRT responders with high predictive power. Both visual and quantitative markers were highly feasible and demonstrated similar results. This work demonstrates the value of imaging LV mechanics and scarring in CRT candidates, which can already be achieved in a clinical routine.
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Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Camilla K. Larsen
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, 0379 Oslo, Norway
| | - Marta Cvijic
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Elena Galli
- Inserm, LTSI-UMR, 1099, 35042 Rennes, France; (E.G.)
- Department of Cardiology, CHU Rennes, 35033 Rennes, France
| | - John M. Aalen
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, 0379 Oslo, Norway
| | - Boudewijn Klop
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Oana Mirea
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Alexis Puvrez
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Laurine Wouters
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Lennert Minten
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Per A. Sirnes
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, 0379 Oslo, Norway
| | - Faraz H. Khan
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, 0379 Oslo, Norway
| | - Gabor Voros
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
| | - Erik Kongsgård
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, 0379 Oslo, Norway
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0379 Oslo, Norway
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Otto A. Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, 0379 Oslo, Norway
| | - Erwan Donal
- Inserm, LTSI-UMR, 1099, 35042 Rennes, France; (E.G.)
- Department of Cardiology, CHU Rennes, 35033 Rennes, France
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium (L.M.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
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4
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Marwick TH, Chandrashekhar Y. Imaging in Cardiac Resynchronization Therapy Needs to Consider More Than Mechanical Delay. JACC Cardiovasc Imaging 2021; 14:1881-1883. [PMID: 34503694 DOI: 10.1016/j.jcmg.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The association of mechanical dyssynchrony and resynchronization therapy with survival in heart failure with a wide QRS complex: a two-world study. Int J Cardiovasc Imaging 2020; 36:1507-1514. [DOI: 10.1007/s10554-020-01865-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
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6
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Duchenne J, Aalen JM, Cvijic M, Larsen CK, Galli E, Bézy S, Beela AS, Ünlü S, Pagourelias ED, Winter S, Hopp E, Kongsgård E, Donal E, Fehske W, Smiseth OA, Voigt JU. Acute redistribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling. Eur Heart J Cardiovasc Imaging 2020; 21:619-628. [DOI: 10.1093/ehjci/jeaa003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/29/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
Aims
Investigating the acute impact of cardiac resynchronization therapy (CRT) on regional myocardial work distribution in the left ventricle (LV) and to which extent it is related to long-term reverse remodelling.
Methods and results
One hundred and thirty heart failure patients, referred for CRT implantation, were recruited in our prospective multicentre study. Regional myocardial work was calculated from non-invasive segmental stress–strain loop area before and immediately after CRT. The magnitude of volumetric reverse remodelling was determined from the change in LV end-systolic volume, 11 ± 2 months after implantation. CRT caused acute redistribution of myocardial work across the LV, with an increase in septal work, and decrease in LV lateral wall work (all P < 0.05). Amongst all LV walls, the acute change in work in the septum and lateral wall of the four-chamber view correlated best and significantly with volumetric reverse remodelling (r = 0.62, P < 0.0001), with largest change seen in patients with most volumetric reverse remodelling. In multivariate linear regression analysis, including conventional parameters, such as pre-implant QRS morphology and duration, LV ejection fraction, ischaemic origin of cardiomyopathy, and the redistribution of work across the septal and lateral walls, the latter appeared as the strongest determinant of volumetric reverse remodelling after CRT (model R2 = 0.414, P < 0.0001).
Conclusion
The acute redistribution of regional myocardial work between the septal and lateral wall of the LV is an important determinant of reverse remodelling after CRT implantation. Our data suggest that the treatment of the loading imbalance should, therefore, be the main aim of CRT.
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Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - John M Aalen
- Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Marta Cvijic
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Camilla K Larsen
- Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Elena Galli
- LTSI, Inserm 1099, University of Rennes, Rennes, France
- Department of Cardiology, CHU Rennes, France
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Serkan Ünlü
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefan Winter
- Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Erik Kongsgård
- Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erwan Donal
- LTSI, Inserm 1099, University of Rennes, Rennes, France
- Department of Cardiology, CHU Rennes, France
| | - Wolfgang Fehske
- Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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Aalen JM, Remme EW, Larsen CK, Andersen OS, Krogh M, Duchenne J, Hopp E, Ross S, Beela AS, Kongsgaard E, Bergsland J, Odland HH, Skulstad H, Opdahl A, Voigt JU, Smiseth OA. Mechanism of Abnormal Septal Motion in Left Bundle Branch Block. JACC Cardiovasc Imaging 2019; 12:2402-2413. [DOI: 10.1016/j.jcmg.2018.11.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 12/28/2022]
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8
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Beela AS, Duchenne J, Petrescu A, Ünlü S, Penicka M, Aakhus S, Winter S, Aarones M, Stefanidis E, Fehske W, Willems R, Szulik M, Kukulski T, Faber L, Ciarka A, Neskovic AN, Stankovic I, Voigt JU. Sex-specific difference in outcome after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2019; 20:504-511. [DOI: 10.1093/ehjci/jey231] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/22/2018] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ahmed S Beela
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, km 4.5 Ring road, Ismailia, Egypt
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Aniela Petrescu
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Martin Penicka
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Svend Aakhus
- Department of Circulation and Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Stefan Winter
- Department of Internal Medicine and Cardiology, Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Marit Aarones
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Evangelos Stefanidis
- Department of Circulation and Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Wolfgang Fehske
- Department of Internal Medicine and Cardiology, Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Zabrze, Poland
| | - Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Zabrze, Poland
| | - Lothar Faber
- Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Aleksandar N Neskovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia
| | - Ivan Stankovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
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9
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Naya M, Manabe O, Koyanagawa K, Tamaki N. The role of nuclear medicine in assessments of cardiac dyssynchrony. J Nucl Cardiol 2018; 25:1980-1987. [PMID: 28956317 DOI: 10.1007/s12350-017-1072-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/30/2022]
Abstract
Radionuclide imaging has an advantage for quantitative analyses of the tracer concentration and its temporal changes. Myocardial perfusion and function have been adapted for synchrony analyses. Extracted parameters have been demonstrated to measure ventricular synchrony and even to predict CRT outcomes. ERNA has the advantages of higher temporal resolution, greater reproducibility, and the volumetric analysis of both ventricles that can be applied for analyses of intraventricular synchrony and interventricular synchrony. Several software packages such as Quantitative Gated SPECT, the Emory Cardiac Toolbox, cardioREPO, and Heart Function View are available to assess the LV dyssynchrony parameters from GSPECT. A count-based method is applied to extract the amplitude and phase from each of the reconstructed GSPECT short-axis datasets throughout the cardiac cycle and then subjected to a Fourier analysis, the results of which are displayed on a polar map and histogram. Some of the parameters such as the bandwidth (expressed as the 95% width of the phase histogram) and the standard deviation of the phase are obtained by the phase histogram to assess the intraventricular synchrony. This review paper focuses on the application of the LV dyssynchrony parameters estimated by cardiac SPECT in patients with a heart disease.
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Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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10
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Role of Gated Myocardial Glucose Metabolic Imaging in Assessing Left Ventricular Systolic Dyssynchrony after Myocardial Infarction and the Influential Factors. Sci Rep 2018; 8:11178. [PMID: 30046056 PMCID: PMC6060098 DOI: 10.1038/s41598-018-29636-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/16/2018] [Indexed: 12/05/2022] Open
Abstract
In this study, we investigated the role of gated myocardial glucose metabolic imaging in assessing left ventricular (LV) systolic dyssynchrony after myocardial infarction (MI) and explored the influencing factors. Bama mini-pigs were divided into normal group and MI group and subjected to gated myocardial metabolic imaging (GMMI) and gated myocardial perfusion imaging (GMPI). The phase bandwidth (BW), standard deviation (SD) and the latest activation site of left ventricle were obtained using program Cedars QGS. The results showed that (1) BW and SD obtained in GMMI and GMPI showed significant correlation in pigs with MI, but not in the normal pigs, (2) BW and SD obtained in GMMI and GMPI had good consistency in both normal pigs and MI pigs, (3) GMMI and GMPI had a 66.7% identity in determining the latest activation site of left ventricle in the normal pigs and 77.8% identity in determining the latest activation site of left ventricle in pigs with MI. Multivariate stepwise regression analysis showed that total perfusion deficit and summed motion score were independent factors affecting BW and SD in GMMI. In conclusion, phase analysis of GMMI images could objectively reflect LV systolic dyssynchrony resulted from interactions of multiple factors.
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Stankovic I, Janicijevic A, Dimic A, Stefanovic M, Vidakovic R, Putnikovic B, Neskovic AN. Mechanical dispersion is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks. Ann Med 2018; 50:128-138. [PMID: 28972811 DOI: 10.1080/07853890.2017.1387282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Bundle branch blocks (BBB)-related mechanical dyssynchrony and dispersion may improve patient selection for device therapy, but their effect on the natural history of this patient population is unknown. METHODS A total of 155 patients with LVEF ≤ 35% and BBB, not treated with device therapy, were included. Mechanical dyssynchrony was defined as the presence of either septal flash or apical rocking. Contraction duration was assessed as time interval from the electrocardiographic R-(Q-)wave to peak longitudinal strain in each of 17 left ventricular segments. Mechanical dispersion was defined as either the standard deviation of all time intervals (dispersionSD) or as the difference between the longest and shortest time intervals (dispersiondelta). Patients were followed for cardiac mortality during a median period of 33 months. RESULTS Mechanical dyssynchrony was not associated with survival. More pronounced mechanical dispersiondelta was found in patients with dyssynchrony than in those without. In the multivariate regression analysis, patients' functional class, diabetes mellitus and dispersiondelta were independently associated with mortality. CONCLUSIONS Mechanical dispersion, but not dyssynchrony, was independently associated with mortality and it may be useful for risk stratification of patients with heart failure (HF) and BBB. Key Messages Mechanical dispersion, measured by strain echocardiography, is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks. Mechanical dispersion may be useful for risk stratification of patients with heart failure and bundle branch blocks.
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Affiliation(s)
- Ivan Stankovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Aleksandra Janicijevic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Aleksandra Dimic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Milica Stefanovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Radosav Vidakovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Biljana Putnikovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Aleksandar N Neskovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
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Saporito S, Houthuizen P, Aben JPMM, Westenberg JJM, van Den Bosch HCM, van Assen HC, Mischi M. Endocardial center motion for quantification of left ventricular discoordination in heart failure using cine MRI. Physiol Meas 2018; 39:025009. [PMID: 29369050 DOI: 10.1088/1361-6579/aaaaa0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare a novel cardiovascular magnetic resonance technique for the assessment of left ventricular (LV) mechanical discoordination by characterizing the endocardial center motion (ECM) in short-axis cine MRI in healthy volunteers and heart failure patients with left bundle branch block (HF-LBBB). APPROACH To evaluate ECM analysis as mechanical discoordination measure, we retrospectively compared spatial and temporal features of the ECM between a group of healthy volunteers (n = 14) and conduction defect patients (HF-LBBB, n = 31). We tracked the center of the endocardial borders on short-axis view MRI cine loops during the cardiac cycle. From the ECM trajectory we calculated the overall traveled distance, the enclosed area, the eccentricity of the trajectory, and the maximum traveled distance. The ECM can be visualized in spatial coordinates as well as by its temporal behavior. We evaluated the classification performance of these measures for LBBB detection. We also quantified the coherence of the ECM on the longitudinal direction by considering the variability of the ECM measures between different short-axis slices. MAIN RESULTS Patients with LBBB showed significantly higher traveled distance (p < 0.0001), enclosed area (p < 0.002), eccentricity (p < 0.02), and peak displacement (p < 0.02) of the endocardial center. Patients with positive late gadolinium enhancement showed a higher variability of ECM measures across different slices (p < 0.05). SIGNIFICANCE ECM analysis is feasible and it allows the assessment of left ventricular mechanical discoordination. Differences in ECM measures permit one to distinguish between LBBB and healthy volunteers.
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Affiliation(s)
- Salvatore Saporito
- Department of Electrical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, Netherlands
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13
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Beela AS, Ünlü S, Duchenne J, Ciarka A, Daraban AM, Kotrc M, Aarones M, Szulik M, Winter S, Penicka M, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Faber L, Stankovic I, Voigt JU. Assessment of mechanical dyssynchrony can improve the prognostic value of guideline-based patient selection for cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2018; 20:66-74. [DOI: 10.1093/ehjci/jey029] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ahmed S Beela
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, km 4.5 Ring road, Ismailia, Egypt
| | - Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Ana Maria Daraban
- Department of Internal Medicine and Gastroenterology, Clinical Emergency Hospital, University of Medicine and Pharmacy ‘Carol Davila’, Bucharest, Romania
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marit Aarones
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland
| | - Stefan Winter
- Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | | | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland
| | - Svend Aakhus
- Department of Circulation and Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology and Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Wolfgang Fehske
- Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Lothar Faber
- Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Ivan Stankovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium
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14
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Stankovic I, Prinz C, Ciarka A, Daraban AM, Mo Y, Aarones M, Szulik M, Winter S, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. Long-Term Outcome After CRT in the Presence of Mechanical Dyssynchrony Seen With Chronic RV Pacing or Intrinsic LBBB. JACC Cardiovasc Imaging 2017; 10:1091-1099. [DOI: 10.1016/j.jcmg.2016.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/15/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
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15
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Pantazopoulos JS, David A, Kostis WJ, Cosgrove NM, Kostis JB. Cardiovascular outcomes in patients with intraventricular conduction blocks: A sixteen-year follow-up in a state-wide database. Hellenic J Cardiol 2016; 58:194-201. [PMID: 27965025 DOI: 10.1016/j.hjc.2016.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To assess the adverse clinical effects of left anterior hemiblock alone or in combination with right bundle branch block and of complete left bundle branch block in comparison with isolated right bundle branch block and the relationship of these effects with altered mechanoelectric factors resulting in left ventricular dysfunction. METHODS In a 16-year follow-up study using a statewide database, we studied the occurrence of mortal and morbid cardiovascular (CV) events among patients without apparent ischemic heart disease who had left anterior hemiblock (LAHB, n=4273, right bundle branch block (RBBB) with LAHB (BFBB, n=1857) and left bundle branch block (LBBB, n=9484 compared to isolated RBBB (n=25288). RESULTS After adjustment for demographics, co-morbidities and insurance, LAHB was associated with a significant excess risk of all-cause death (HR 1.134, 95% CI 1.061-1.213, p=0.0002) and CV death (HR 1.329, 95% CI 1.174-1.501, p<0.0001). BFBB was associated with excess HF (HR 1.190, 95% CI 1.048-1.351, p<0.0071), all-cause death (HR 1.440, 95% CI 1.045-1.252, p=0.0036) and CV death (HR 1.210, 95% CI 1.020-1.436, p<0.0001). LBBB was associated with an excess risk of MR (HR 1.307, 95% CI 1.116-1.530, p<0.0009), HF 1.177, 95% CI1.097-1.263, p<0.0001) and CV death (HR 1.220, 95% CI 1.106-1.345, p<0.0001). CONCLUSIONS In patients without apparent ischemic heart disease, the presence of LAHB alone or in combination with RBBB imparts increased risk of CV and all-cause death compared to isolated RBBB. BFBB is also associated with an increased risk of HF.
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Affiliation(s)
- John S Pantazopoulos
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Alice David
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William J Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nora M Cosgrove
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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16
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Popović ZB, Koneru S. When the Left Ventricle Rocks. JACC Cardiovasc Imaging 2016; 9:665-7. [DOI: 10.1016/j.jcmg.2015.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 07/23/2015] [Indexed: 11/26/2022]
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17
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Voigt JU. Cardiac resynchronization therapy responders can be better identified by specific signatures in myocardial function. Eur Heart J Cardiovasc Imaging 2015; 17:132-3. [PMID: 26590398 DOI: 10.1093/ehjci/jev291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Gasthuisberg, University Hospital Leuven, Herestraat 49, Leuven 3000, Belgium
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18
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Stankovic I, Prinz C, Ciarka A, Daraban AM, Kotrc M, Aarones M, Szulik M, Winter S, Belmans A, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT). Eur Heart J Cardiovasc Imaging 2015; 17:262-9. [DOI: 10.1093/ehjci/jev288] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/04/2015] [Indexed: 11/14/2022] Open
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