1
|
Galli E, Galand V, Le Rolle V, Taconne M, Wazzan AA, Hernandez A, Leclercq C, Donal E. The saga of dyssynchrony imaging: Are we getting to the point. Front Cardiovasc Med 2023; 10:1111538. [PMID: 37063957 PMCID: PMC10103462 DOI: 10.3389/fcvm.2023.1111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
Cardiac resynchronisation therapy (CRT) has an established role in the management of patients with heart failure, reduced left ventricular ejection fraction (LVEF < 35%) and widened QRS (>130 msec). Despite the complex pathophysiology of left ventricular (LV) dyssynchrony and the increasing evidence supporting the identification of specific electromechanical substrates that are associated with a higher probability of CRT response, the assessment of LVEF is the only imaging-derived parameter used for the selection of CRT candidates.This review aims to (1) provide an overview of the evolution of cardiac imaging for the assessment of LV dyssynchrony and its role in the selection of patients undergoing CRT; (2) highlight the main pitfalls and advantages of the application of cardiac imaging for the assessment of LV dyssynchrony; (3) provide some perspectives for clinical application and future research in this field.Conclusionthe road for a more individualized approach to resynchronization therapy delivery is open and imaging might provide important input beyond the assessment of LVEF.
Collapse
|
2
|
Andreini D, Conte E, Mushtaq S, Melotti E, Gigante C, Mancini ME, Guglielmo M, Lo Russo G, Baggiano A, Annoni A, Formenti A, Magini A, Pontone G, Agostoni P, Bartorelli AL, Pepi M, Onuma Y, Serruys PW. Comprehensive Evaluation of Left Ventricle Dysfunction by a New Computed Tomography Scanner: The E-PLURIBUS Study. JACC Cardiovasc Imaging 2023; 16:175-188. [PMID: 36444769 DOI: 10.1016/j.jcmg.2022.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although cardiac magnetic resonance (CMR) is considered the gold standard for myocardial fibrosis detection, cardiac computed tomography (CCT) is emerging as a promising alternative. OBJECTIVES The purpose of this study was to assess feasibility and diagnostic accuracy of a comprehensive functional and anatomical evaluation with CCT as compared with CMR in patients with newly diagnosed left ventricular dysfunction (LVD). METHODS A total of 128 consecutive patients with newly diagnosed LVD were screened. Based on the exclusion criteria, 28 cases were excluded. CCT was performed within 10 days from CMR. Biventricular volumes and ejection fraction, and presence and pattern of delayed enhancement (DE), were determined, along with evaluation of coronary arteries among patients undergoing invasive angiography in the 6 months after CCT. RESULTS Six cases were excluded because of claustrophobia at CMR. Among the 94 patients who formed the study population, the concordance between CCT and CMR in suggesting the cause of the LVD was high (94.7%, 89/94 patients) in the overall population and was 100% for identifying ischemic cardiomyopathy. The CCT diagnostic rate for DE assessment was also high (96.7%, 1,544/1,598 territories) and similar to that of CMR (97.4%; P = 0.345, CCT vs CMR). Moreover, CCT showed high diagnostic accuracy in the detection of DE (94.8%, 95% CI: 93.6%-95.8%) in a territory-based analysis. Biventricular volumes and function parameters as measured by CCT and CMR were similar, without significant differences with the exception of a modest difference in RV volume. CCT was confirmed to be accurate for assessing arterial coronary circulation. The mean radiation exposure of the whole CCT was 7.78 ± 2.53 mSv (0.84 ± 0.24 mSv for DE). CONCLUSIONS CCT performed with low-dose whole-heart coverage scanner and high-concentration contrast agent appears an effective noninvasive tool for a comprehensive assessment of patients with newly diagnosed LVD.
Collapse
Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedial Science for Health, University of Milan, Milan
| | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom
| |
Collapse
|
3
|
Al-Mashat M, Borgquist R, Carlsson M, Arheden H, Jögi J. Pulmonary perfusion and NYHA classification improve after cardiac resynchronization therapy. J Nucl Cardiol 2022; 29:2974-2983. [PMID: 34750725 PMCID: PMC9834347 DOI: 10.1007/s12350-021-02848-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/05/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Evaluation of cardiac resynchronization therapy (CRT) often includes New York Heart Association (NYHA) classification, and echocardiography. However, these measures have limitations. Perfusion gradients from ventilation/perfusion single-photon emission computed tomography (V/P SPECT) are related to left-heart filling pressures and have been validated against invasive right-heart catheterization. The aim was to assess if changes in perfusion gradients are associated with improvements in heart failure (HF) symptoms after CRT, and if they correlate with currently used diagnostic methods in the follow-up of patients with HF after receiving CRT. METHODS AND RESULTS Nineteen patients underwent V/P SPECT, echocardiography, NYHA classification, and the quality-of-life scoring system "Minnesota living with HF" (MLWHF), before and after CRT. CRT caused improvement in perfusion gradients from V/P SPECT which were associated with improvements in NYHA classification (P = .0456), whereas improvements in end-systolic volume (LVESV) from echocardiography were not. After receiving CRT, the proportion of patients who improved was lower using LVESV (n = 7/19, 37%) than perfusion gradients (n = 13/19, 68%). Neither change in perfusion gradients nor LVESV was associated with changes in MLWHF (P = 1.0, respectively). CONCLUSIONS Measurement of perfusion gradients from V/P SPECT is a promising quantitative user-independent surrogate measure of left-sided filling pressure in the assessment of CRT response in patients with HF.
Collapse
Affiliation(s)
- Mariam Al-Mashat
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Entrégatan 7, 22185, Lund, Sweden
| | - Rasmus Borgquist
- Cardiology, Arrhythmia Section, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Entrégatan 7, 22185, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Entrégatan 7, 22185, Lund, Sweden
| | - Jonas Jögi
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Entrégatan 7, 22185, Lund, Sweden.
| |
Collapse
|
4
|
Atehortúa A, Romero E, Garreau M. Characterization of motion patterns by a spatio-temporal saliency descriptor in cardiac cine MRI. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 218:106714. [PMID: 35263659 DOI: 10.1016/j.cmpb.2022.106714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Abnormalities of the heart motion reveal the presence of a disease. However, a quantitative interpretation of the motion is still a challenge due to the complex dynamics of the heart. This work proposes a quantitative characterization of regional cardiac motion patterns in cine magnetic resonance imaging (MRI) by a novel spatio-temporal saliency descriptor. METHOD The strategy starts by dividing the cardiac sequence into a progression of scales which are in due turn mapped to a feature space of regional orientation changes, mimicking the multi-resolution decomposition of oriented primitive changes of visual systems. These changes are estimated as the difference between a particular time and the rest of the sequence. This decomposition is then temporarily and regionally integrated for a particular orientation and then for the set of different orientations. A final spatio-temporal 4D saliency map is obtained as the summation of the previously integrated information for the available scales. The saliency dispersion of this map was computed in standard cardiac locations as a measure of the regional motion pattern and was applied to discriminate control and hypertrophic cardiomyopathy (HCM) subjects during the diastolic phase. RESULTS Salient motion patterns were estimated from an experimental set, which consisted of 3D sequences acquired by MRI from 108 subjects (33 control, 35 HCM, 20 dilated cardiomyopathy (DCM), and 20 myocardial infarction (MINF) from heterogeneous datasets). HCM and control subjects were classified by an SVM that learned the salient motion patterns estimated from the presented strategy, by achieving a 94% AUC. In addition, statistical differences (test t-student, p<0.05) were found among groups of disease in the septal and anterior ventricular segments at both the ED and ES, with salient motion characteristics aligned with existing knowledge on the diseases. CONCLUSIONS Regional wall motion abnormality in the apical, anterior, basal, and inferior segments was associated with the saliency dispersion in HCM, DCM, and MINF compared to healthy controls during the systolic and diastolic phases. This saliency analysis may be used to detect subtle changes in heart function.
Collapse
Affiliation(s)
- Angélica Atehortúa
- Universidad Nacional de Colombia, Bogotá, Colombia; Univ Rennes, Inserm, LTSI UMR 1099, Rennes F-35000, France
| | | | | |
Collapse
|
5
|
Khamzin S, Dokuchaev A, Bazhutina A, Chumarnaya T, Zubarev S, Lyubimtseva T, Lebedeva V, Lebedev D, Gurev V, Solovyova O. Machine Learning Prediction of Cardiac Resynchronisation Therapy Response From Combination of Clinical and Model-Driven Data. Front Physiol 2022; 12:753282. [PMID: 34970154 PMCID: PMC8712879 DOI: 10.3389/fphys.2021.753282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Up to 30–50% of chronic heart failure patients who underwent cardiac resynchronization therapy (CRT) do not respond to the treatment. Therefore, patient stratification for CRT and optimization of CRT device settings remain a challenge. Objective: The main goal of our study is to develop a predictive model of CRT outcome using a combination of clinical data recorded in patients before CRT and simulations of the response to biventricular (BiV) pacing in personalized computational models of the cardiac electrophysiology. Materials and Methods: Retrospective data from 57 patients who underwent CRT device implantation was utilized. Positive response to CRT was defined by a 10% increase in the left ventricular ejection fraction in a year after implantation. For each patient, an anatomical model of the heart and torso was reconstructed from MRI and CT images and tailored to ECG recorded in the participant. The models were used to compute ventricular activation time, ECG duration and electrical dyssynchrony indices during intrinsic rhythm and BiV pacing from the sites of implanted leads. For building a predictive model of CRT response, we used clinical data recorded before CRT device implantation together with model-derived biomarkers of ventricular excitation in the left bundle branch block mode of activation and under BiV stimulation. Several Machine Learning (ML) classifiers and feature selection algorithms were tested on the hybrid dataset, and the quality of predictors was assessed using the area under receiver operating curve (ROC AUC). The classifiers on the hybrid data were compared with ML models built on clinical data only. Results: The best ML classifier utilizing a hybrid set of clinical and model-driven data demonstrated ROC AUC of 0.82, an accuracy of 0.82, sensitivity of 0.85, and specificity of 0.78, improving quality over that of ML predictors built on clinical data from much larger datasets by more than 0.1. Distance from the LV pacing site to the post-infarction zone and ventricular activation characteristics under BiV pacing were shown as the most relevant model-driven features for CRT response classification. Conclusion: Our results suggest that combination of clinical and model-driven data increases the accuracy of classification models for CRT outcomes.
Collapse
Affiliation(s)
- Svyatoslav Khamzin
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Arsenii Dokuchaev
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Anastasia Bazhutina
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.,Ural Federal University, Yekaterinburg, Russia
| | - Tatiana Chumarnaya
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Stepan Zubarev
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | | | - Dmitry Lebedev
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Olga Solovyova
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.,Ural Federal University, Yekaterinburg, Russia
| |
Collapse
|
6
|
Kheiri B, Przybylowicz R, Simpson TF, Merrill M, Osman M, Dalouk K, Rahmouni H, Stecker E, Nazer B, Henrikson CA. Imaging-guided cardiac resynchronization therapy: A meta-analysis of randomized controlled trials. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1570-1576. [PMID: 34255376 DOI: 10.1111/pace.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/07/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Among patients with heart failure and left ventricular (LV) dysfunction despite guideline directed medical therapy, cardiac resynchronization (CRT) is an effective technology to reverse LV remodeling. Given that a large portion of patients are non-responders, alternatives to traditional LV-lead placement have been explored. A promising alternative is image targeted placement of an LV-lead to latest mechanically activated segment without scar. METHODS Electronic database search for randomized controlled trials (RCTs) that evaluated the imaging-guided LV-lead placement on clinical, echocardiographic, and functional outcomes. The primary outcome was a composite of mortality and heart failure hospitalization. The secondary outcomes included CRT responders, New York Heart Association (NYHA), 6-minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and ejection fraction (EF) changes. RESULTS Analysis included 4 RCTs of 691 patients with an average follow-up of 2 years (age 69.5 ± 10.3 years, 76% males, 54% ischemic cardiomyopathy, 81% with NYHA classes III/IV, and EF of 24.4% ± 8). The most common site for LV-lead paced segment was the anterolateral segment (45%) and at mid-LV (49%). Compared with the control, imaging-guided LV-lead placement was associated with a significant reduction of the primary outcome (hazard ratio [HR] = 0.60; 95% CI = 0.40-0.88; p = .01), higher CRT responders (odd ratio [OR] = 2.10; p < .01), more NYHA improvements by ≥1 (OR = 1.89; p = .01), increased 6MWT (mean difference [MD] = 25.78 feet; p < .01), and lower MLHFQ (MD = -4.04; p = .04), without significant differences in the LVEF (p = .08). CONCLUSIONS In patients undergoing CRT, imaging-guided LV-lead placement was associated with improved clinical, echocardiographic, and functional status.
Collapse
Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Ryle Przybylowicz
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Timothy F Simpson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Miranda Merrill
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Mohammed Osman
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.,Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Khidir Dalouk
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Hind Rahmouni
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Eric Stecker
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
7
|
Borgquist R, Carlsson M, Markstad H, Werther-Evaldsson A, Ostenfeld E, Roijer A, Bakos Z. Cardiac Resynchronization Therapy Guided by Echocardiography, MRI, and CT Imaging: A Randomized Controlled Study. JACC Clin Electrophysiol 2020; 6:1300-1309. [PMID: 33092758 DOI: 10.1016/j.jacep.2020.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study evaluated if selecting the left ventricular (LV) target segment by echocardiography-derived late mechanical activation, with access to multimodality imaging for scar and venous anatomy, could help to increase responder rates to cardiac resynchronization therapy (CRT). BACKGROUND LV lead placement is important for clinical outcome, but the optimal strategy for LV lead placement in CRT is still debated. METHODS This study conducted a prospective, blinded randomized controlled trial on 102 patients with indication for CRT (27% women, 46% with ischemic cardiomyopathy, 63% in New York Heart Association functional class III, 74% with left bundle branch block, and with mean ejection fraction of 23%). Optimal LV lead location was defined as the latest mechanically activated available segment (free of transmural scar), determined by radial strain echocardiography, cardiac computed tomography, and cardiac magnetic resonance (n = 70). The primary endpoint was reduction of LV end-systolic volume by ≥15% at 6 months post-implantation. RESULTS Patients were followed for 47 ± 21 months. Based on imaging, optimal or adjacent lead placement was feasible in 96% of all cases and was obtained in 83% of the intervention group versus 80% of the control group. Fifty-six percent of the patients were LV end-systolic volume responders compared with the control group (55%) (p = 0.96), and 71% improved ≥1 New York Heart Association functional class (74% vs. 67%; p = 0.43). Death or heart failure hospitalization within 2 years occurred in 6% (2% of the intervention group vs. 10% of the control group; p = 0.07). CONCLUSIONS Radial strain-guided LV lead placement, in combination with multimodality imaging, did not result in increased clinical or echocardiographic response, nor in a significant reduction of death or heart failure hospitalization. (Combining Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in CRT Treatment [CRT Clinic]; NCT01426321).
Collapse
Affiliation(s)
- Rasmus Borgquist
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden.
| | - Marcus Carlsson
- Clinical Physiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Hanna Markstad
- Radiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Anna Werther-Evaldsson
- Heart Failure and Valvular Heart Disease Section, Skane University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden; Radiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Anders Roijer
- Heart Failure and Valvular Heart Disease Section, Skane University Hospital, Lund, Sweden
| | - Zoltan Bakos
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
8
|
Andreini D, Conte E, Mushtaq S, Pontone G, Guglielmo M, Baggiano A, Annoni A, Mancini ME, Formenti A, Nicoli F, Tanzilli A, Muscogiuri G, Magini A, Agostoni P, Bartorelli AL, Fiorentini C, Pepi M. Rationale and design of the EPLURIBUS Study (Evidence for a comPrehensive evaLUation of left ventRicle dysfnctIon By a whole-heart coverage cardiac compUted tomography Scanner). J Cardiovasc Med (Hagerstown) 2020; 21:812-819. [DOI: 10.2459/jcm.0000000000001051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
9
|
Surface electrogram-guided left ventricular lead placement improves response to cardiac resynchronization therapy. Anatol J Cardiol 2019. [PMID: 29521312 PMCID: PMC5864768 DOI: 10.14744/anatoljcardiol.2018.09216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Failure to select the optimal left ventricular (LV) segment for lead implantation is one of the most important causes of unresponsiveness to the cardiac resynchronization therapy (CRT). In our study, we aimed to investigate the echocardiographic and clinical benefits of LV lead implantation guided by an intraoperative 12-lead surface electrocardiogram (ECG) in patients with multiple target veins. METHODS We included 80 [42 (62.5%) male] heart failure patients who successfully underwent CRT defibrillator (CRT-D) implantation. Patients were divided into two groups. In group 1, LV lead was positioned at the site with the shortest biventricular-paced (BiV-paced) QRS duration (QRSd), as intraprocedurally measured using surface ECG. In group 2 (control), we included patients who underwent the standard unguided CRT. ECG, echocardiogram, and functional status were evaluated before and 6 months after CRT implantation in all patients. RESULTS In group 1, BiV-paced QRSd measurements were successfully performed in 112 of 120 coronary sinus branches during CRT and an LV lead was successfully placed at the optimal site in all patients. Compared with group 2, group 1 had a significantly higher rate (85% vs. 50%, p=0.02) of response (>15% reduction in LV end-systolic volume) to CRT as well as a shorter QRSd (p<0.001) and a greater QRS shortening (ΔQRS) associated with CRT compared with baseline (p<0.001). The mean New York Heart Association functional class was significantly improved in both groups, and no significant differences were found in clinical response to CRT (85% vs. 70%, p=0.181). CONCLUSION Surface ECG can be used to guide LV lead placement in patients with multiple target veins for improving response to CRT. Thus, it is a safe, feasible, and economic approach for CRT-D implantation.
Collapse
|
10
|
Time interval from left ventricular stimulation to QRS onset is a novel predictor of nonresponse to cardiac resynchronization therapy. Heart Rhythm 2019; 16:395-402. [DOI: 10.1016/j.hrthm.2018.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Indexed: 11/23/2022]
|
11
|
Abstract
Cardiac resynchronization therapy (CRT) improves cardiac mechanics and quality of life in many patients with evidence of electromechanical cardiac dyssynchrony. However, up to 30% of patients receiving CRT do not respond to therapy. The mediator for poor response likely varies among patients; however, careful evaluation of mechanical dyssynchrony may inform management strategies. In this article, some of the methods and supporting evidence for dyssynchrony assessment with MRI as a predictor for CRT response are presented. The case is made for pre-implant assessment with MRI because of its ability to characterize scar, coronary venous distribution, and regional strain patterns.
Collapse
Affiliation(s)
- Edmond Obeng-Gyimah
- Department of Medicine, Cardiovascular Division, Clinical Cardiac Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Saman Nazarian
- Department of Medicine, Cardiovascular Division, Clinical Cardiac Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
12
|
Sassone B, Nucifora G, Mele D, Valzania C, Bisignani G, Boriani G. Role of cardiovascular imaging in cardiac resynchronization therapy: a literature review. J Cardiovasc Med (Hagerstown) 2018; 19:211-222. [PMID: 29470248 DOI: 10.2459/jcm.0000000000000635] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Cardiac resynchronization therapy (CRT) is an established treatment in patients with symptomatic drug-refractory heart failure and broad QRS complex on the surface ECG. Despite the presence of either mechanical dyssynchrony or viable myocardium at the site where delivering left ventricular pacing being necessary conditions for a successful CRT, their direct assessment by techniques of cardiovascular imaging, though feasible, is not recommended in clinical practice by the current guidelines. Indeed, even though there is growing body of data providing evidence of the additional value of an image-based approach as compared with routine approach in improving response to CRT, these results should be confirmed in prospective and large multicentre trials before their impact on CRT guidelines is considered.
Collapse
Affiliation(s)
- Biagio Sassone
- Department of Cardiology, SS.ma Annunziata Hospital.,Department of Cardiology, Delta Hospital, Azienda Unità Sanitaria Locale Ferrara, Ferrara, Italy
| | - Gaetano Nucifora
- Cardiology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Flinders University, Adelaide, Australia
| | - Donato Mele
- Noninvasive Cardiology Unit, University Hospital of Ferrara, Ferrara
| | - Cinzia Valzania
- Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | | |
Collapse
|
13
|
Nguyên UC, Cluitmans MJM, Strik M, Luermans JG, Gommers S, Wildberger JE, Bekkers SCAM, Volders PGA, Mihl C, Prinzen FW, Vernooy K. Integration of cardiac magnetic resonance imaging, electrocardiographic imaging, and coronary venous computed tomography angiography for guidance of left ventricular lead positioning. Europace 2018; 21:626-635. [DOI: 10.1093/europace/euy292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthijs J M Cluitmans
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marc Strik
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Justin G Luermans
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Suzanne Gommers
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sebastiaan C A M Bekkers
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul G A Volders
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Casper Mihl
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
14
|
Visualisation of coronary venous anatomy by computed tomography angiography prior to cardiac resynchronisation therapy implantation. Neth Heart J 2018; 26:433-444. [PMID: 30030750 PMCID: PMC6115304 DOI: 10.1007/s12471-018-1132-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to illustrate the additive value of computed tomography angiography (CTA) for visualisation of the coronary venous anatomy prior to cardiac resynchronisation therapy (CRT) implantation. METHODS Eighteen patients planned for CRT implantation were prospectively included. A specific CTA protocol designed for visualisation of the coronary veins was carried out on a third-generation dual-source CT platform. Coronary veins were semi-automatically segmented to construct a 3D model. CTA-derived coronary venous anatomy was compared with intra-procedural fluoroscopic angiography (FA) in right and left anterior oblique views. RESULTS Coronary venous CTA was successfully performed in all 18 patients. CRT implantation and FA were performed in 15 patients. A total of 62 veins were visualised; the number of veins per patient was 3.8 (range: 2-5). Eighty-five per cent (53/62) of the veins were visualised on both CTA and FA, while 10% (6/62) were visualised on CTA only, and 5% (3/62) on FA only. Twenty-two veins were present on the lateral or inferolateral wall; of these, 95% (21/22) were visualised by CTA. A left-sided implantation was performed in 13 patients, while a right-sided implantation was performed in the remaining 2 patients because of a persistent left-sided superior vena cava with no left innominate vein on CTA. CONCLUSION Imaging of the coronary veins by CTA using a designated protocol is technically feasible and facilitates the CRT implantation approach, potentially improving the outcome.
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Spartalis M, Tzatzaki E, Spartalis E, Damaskos C, Athanasiou A, Livanis E, Voudris V. The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives. Open Cardiovasc Med J 2017; 11:133-145. [PMID: 29387277 PMCID: PMC5748829 DOI: 10.2174/1874192401711010133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/24/2023] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders). Objective: This review provides a conceptual description of the role of echocardiography in the optimization of CRT. Method: A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography. Results: A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations. Conclusion: LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.
Collapse
Affiliation(s)
- Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleni Tzatzaki
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | - Christos Damaskos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | | | - Efthimios Livanis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| |
Collapse
|
17
|
Left Ventricular Lead Position Guided by Parametric Strain Echocardiography Improves Response to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2017; 30:1001-1011. [DOI: 10.1016/j.echo.2017.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 01/11/2023]
|
18
|
Standardized unfold mapping: a technique to permit left atrial regional data display and analysis. J Interv Card Electrophysiol 2017; 50:125-131. [PMID: 28884216 PMCID: PMC5633640 DOI: 10.1007/s10840-017-0281-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/10/2017] [Indexed: 10/28/2022]
Abstract
PURPOSE Left atrial arrhythmia substrate assessment can involve multiple imaging and electrical modalities, but visual analysis of data on 3D surfaces is time-consuming and suffers from limited reproducibility. Unfold maps (e.g., the left ventricular bull's eye plot) allow 2D visualization, facilitate multimodal data representation, and provide a common reference space for inter-subject comparison. The aim of this work is to develop a method for automatic representation of multimodal information on a left atrial standardized unfold map (LA-SUM). METHODS The LA-SUM technique was developed and validated using 18 electroanatomic mapping (EAM) LA geometries before being applied to ten cardiac magnetic resonance/EAM paired geometries. The LA-SUM was defined as an unfold template of an average LA mesh, and registration of clinical data to this mesh facilitated creation of new LA-SUMs by surface parameterization. RESULTS The LA-SUM represents 24 LA regions on a flattened surface. Intra-observer variability of LA-SUMs for both EAM and CMR datasets was minimal; root-mean square difference of 0.008 ± 0.010 and 0.007 ± 0.005 ms (local activation time maps), 0.068 ± 0.063 gs (force-time integral maps), and 0.031 ± 0.026 (CMR LGE signal intensity maps). Following validation, LA-SUMs were used for automatic quantification of post-ablation scar formation using CMR imaging, demonstrating a weak but significant relationship between ablation force-time integral and scar coverage (R 2 = 0.18, P < 0.0001). CONCLUSIONS The proposed LA-SUM displays an integrated unfold map for multimodal information. The method is applicable to any LA surface, including those derived from imaging and EAM systems. The LA-SUM would facilitate standardization of future research studies involving segmental analysis of the LA.
Collapse
|
19
|
Nguyên UC, Prinzen FW, Vernooy K. Left ventricular lead positioning in cardiac resynchronization therapy: Mission accomplished? Heart Rhythm 2017; 14:1373-1374. [DOI: 10.1016/j.hrthm.2017.05.030] [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: 05/09/2017] [Indexed: 10/19/2022]
|
20
|
Galli E, Leclercq C, Donal E. Mechanical dyssynchrony in heart failure: Still a valid concept for optimizing treatment? Arch Cardiovasc Dis 2017; 110:60-68. [DOI: 10.1016/j.acvd.2016.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/15/2022]
|
21
|
Nguyên UC, Mafi-Rad M, Aben JP, Smulders MW, Engels EB, van Stipdonk AMW, Luermans JGLM, Bekkers SCAM, Prinzen FW, Vernooy K. A novel approach for left ventricular lead placement in cardiac resynchronization therapy: Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging. Heart Rhythm 2016; 14:110-119. [PMID: 27663606 DOI: 10.1016/j.hrthm.2016.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Placing the left ventricular (LV) lead at a site of late electrical activation remote from scar is desired to improve cardiac resynchronization therapy (CRT) response. OBJECTIVE The purpose of this study was to integrate coronary venous electroanatomic mapping (EAM) with delayed enhancement cardiac magnetic resonance (DE-CMR) enabling LV lead guidance to the latest activated vein remote from scar. METHODS Eighteen CRT candidates with focal scar on DE-CMR were prospectively included. DE-CMR images were semi-automatically analyzed. Coronary venous EAM was performed intraprocedurally and integrated with DE-CMR to guide LV lead placement in real time. Image integration accuracy and electrogram parameters were evaluated offline. RESULTS Integration of EAM and DE-CMR was achieved using 8.9 ± 2.8 anatomic landmarks and with accuracy of 4.7 ± 1.1 mm (mean ± SD). Maximal electrical delay ranged between 72 and 197ms (57%-113% of QRS duration) and was heterogeneously located among individuals. In 12 patients, the latest activated vein was located outside scar, and placing the LV lead in the latest activated vein remote from scar was accomplished in 10 patients and prohibited in 2 patients. In the other 6 patients, the latest activated vein was located in scar, and targeting alternative veins was considered. Unipolar voltages were on average lower in scar compared to nonscar (6.71 ± 3.45 mV vs 8.18 ± 4.02 mV [median ± interquartile range), P <.001) but correlated weakly with DE-CMR scar extent (R -0.161, P <.001) and varied widely among individual patients. CONCLUSION Integration of coronary venous EAM with DE-CMR can be used during CRT implantation to guide LV lead placement to the latest activated vein remote from scar, possibly improving CRT.
Collapse
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
| | - Masih Mafi-Rad
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Martijn W Smulders
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Elien B Engels
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
22
|
Absence of coronary sinus tributaries in ischemic cardiomyopathy: An insight from multidetector computed tomography cardiac venographic study. J Cardiovasc Comput Tomogr 2016; 10:156-61. [DOI: 10.1016/j.jcct.2016.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/04/2016] [Accepted: 01/26/2016] [Indexed: 01/23/2023]
|
23
|
Gerber BL, Edvardsen T, Pierard LA, Saraste A, Knuuti J, Maurer G, Habib G, Lancellotti P. The year 2014 in the European Heart Journal--Cardiovascular Imaging: part II. Eur Heart J Cardiovasc Imaging 2015; 16:1180-4. [PMID: 26377903 DOI: 10.1093/ehjci/jev223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022] Open
Abstract
The European Heart Journal-Cardiovascular Imaging, created in 2012, has become a reference for publishing multimodality cardiovascular imaging scientific and review papers. The impressive 2014 impact factor of 4.105 confirms the important position of our journal. In this part, we summarize the most important studies from the journal's third year, with specific emphasis on cardiomyopathies, congenital heart diseases, valvular heart diseases, and heart failure.
Collapse
Affiliation(s)
- Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway Centre of Cardiological Innovation, Oslo, Norway
| | - Luc A Pierard
- Avenue de l'hôpital, 1, Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, Imaging Cardiology, CHU Sart Tilman, 4000 Liege, Belgium
| | - Antti Saraste
- Turku PET Centre and Heart Center, Turku University Hospital and University of Turku, Kiinmyllynkatu 4-8, 20520 Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre and Heart Center, Turku University Hospital and University of Turku, Kiinmyllynkatu 4-8, 20520 Turku, Finland
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gilbert Habib
- Aix-Marseille Université, 13284 Marseille, France Department of Cardiology, La Timone Hospital, Bd Jean Moulin, 13005 Marseille, France
| | - Patrizio Lancellotti
- Avenue de l'hôpital, 1, Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, Imaging Cardiology, CHU Sart Tilman, 4000 Liege, Belgium GVM Care and Research, E.S. Health Science Foundation, Lugo, RA, Italy
| |
Collapse
|
24
|
Tummala LS, Young RK, Singh T, Jani S, Srichai MB. Role of Non-invasive Imaging in the Work-Up of Cardiomyopathies. Curr Atheroscler Rep 2015; 17:486. [DOI: 10.1007/s11883-014-0486-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
25
|
Laksman Z, Yee R, Stirrat J, Gula LJ, Skanes AC, Leong-Sit P, Manlucu J, McCarty D, Turkistani Y, Scholl D, Rajchl M, Goela A, Islam A, Thompson RT, Drangova M, White JA. Model-based navigation of left and right ventricular leads to optimal targets for cardiac resynchronization therapy: a single-center feasibility study. Circ Arrhythm Electrophysiol 2014; 7:1040-7. [PMID: 25221334 DOI: 10.1161/circep.114.001729] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Left ventricular (LV) and right ventricular pacing site characteristics have been shown to influence response to cardiac resynchronization therapy (CRT). This study aimed to determine the clinical feasibility of image-guided lead delivery using a 3-dimensional navigational model displaying both LV and right ventricular (RV) pacing targets. Serial echocardiographic measures of clinical response and procedural metrics were evaluated. METHODS AND RESULTS Thirty-one consecutive patients underwent preimplant cardiac MRI with the generation of a 3-dimensional navigational model depicting optimal segmental targets for LV and RV leads. Lead delivery was guided by the model in matched views to intraprocedural fluoroscopy. Blinded assessment of final lead tip location was performed from postprocedural cardiac computed tomography. Clinical and LV remodeling response criteria were assessed at baseline, 3 months, and 6 months using a 6-minute hall walk, quality of life questionnaire, and echocardiography. Mean age and LV ejection fraction was 66 ± 8 years and 26 ± 8%, respectively. LV leads were successfully delivered to a target or adjacent segment in 30 of 31 patients (97%), 68% being nonposterolateral. RV leads were delivered to a target or adjacent segment in 30 of 31 patients (97%), 26% being nonapical. Twenty-three patients (74%) met standard criteria for response (LV end-systolic volume reduction ≥ 15%), 18 patients (58%) for super-response (LV end-systolic volume reduction ≥ 30%). LV ejection fraction improved at 6 months (31 ± 8 versus 26 ± 8%, P=0.04). CONCLUSIONS This study demonstrates clinical feasibility of dual cardiac resynchronization therapy lead delivery to optimal targets using a 3-dimensional navigational model. High procedural success, acceptable procedural times, and a low rate of early procedural complications were observed. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01640769.
Collapse
Affiliation(s)
- Zachary Laksman
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Raymond Yee
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - John Stirrat
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Lorne J Gula
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Allan C Skanes
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Peter Leong-Sit
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Jamie Manlucu
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - David McCarty
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Yosra Turkistani
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - David Scholl
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Martin Rajchl
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Aashish Goela
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Ali Islam
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - R Terry Thompson
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - Maria Drangova
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.)
| | - James A White
- From the Division of Cardiology, Department of Medicine (Z.L., R.Y., L.J.G., A.C.S., P.L.-S., J.M., D.M.C., Y.T., J.A.W.), Imaging Laboratories, Robarts Research Institute (J.S., D.S., M.R., M.D.), and Lawson Health Research Institute (R.T.T.), University of Western Ontario, London, Ontario; Department of Medical Imaging, Schulich School of Medicine and Dentistry, London, Ontario (A.G., A.I., R.T.T., M.D.); and Department of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (J.A.W.).
| |
Collapse
|