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Passafaro F, Rapacciuolo A, Ruocco A, Ammirati G, Crispo S, Pasceri E, Santarpia G, Mauro C, Esposito G, Indolfi C, Curcio A. COMPArison of Multi-Point Pacing and ConvenTional Cardiac Resynchronization Therapy Through Noninvasive Hemodynamics Measurement: Short- and Long-Term Results of the COMPACT-MPP Study. Am J Cardiol 2024; 215:42-49. [PMID: 38237796 DOI: 10.1016/j.amjcard.2023.12.057] [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: 10/15/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
Invasive hemodynamic studies have shown improved left ventricular (LV) performances when cardiac resynchronization therapy/defibrillator is delivered through multipoint pacing (MPP). Nowadays, strategies have become available that allow studying the same hemodynamic parameters at a noninvasive level. The aim of the present study was to evaluate the clinical implication of using a patient-tailored approach for cardiac resynchronization therapy programming based on noninvasively assessed LV hemodynamics to identify the best biventricular pacing modality between standard single-site pacing (STD) and MPP for each patient. Therefore, 51 patients with heart failure (age 69 ± 9 years, 35 men, 27% ischemic etiology) implanted with cardiac resynchronization therapy/defibrillator underwent noninvasive LV function assessment through photoplethysmography before hospital discharge for addressing dP/dt and stroke volume in both pacing modalities (STD and MPP). The modality that performed better in terms of hemodynamic improvement was permanently programmed. Global longitudinal strain (GLS) was also assessed, and repeated at 3 months. Compared with intrinsic rhythm (928 ± 486 mm Hg/s), dP/dtmax showed a trend to increase in both biventricular pacing modes (1,000 ± 577 mm Hg/s in STD, 1,036 ± 530 mm Hg/s in MPP, p = NS). MPP was associated with a wider hemodynamic improvement than was STD and was the modality of choice in 34 of 51 patients (67%). GLS at predischarge did not differ between groups (-10.3 ± 3.8% vs -10.2 ± 3.5%), but significant improvement of ejection fraction at 1 month (34.4 ± 5.3%, p <0.001) and of GLS at 3 months (-12.9 ± 2.9%, p <0.005) was observed across the entire cohort. At 3 months, 77% of patients were classified as responders. Interestingly, long-term (3 years) follow-up unveiled a reduction in all-cause mortality in the MPP group compared with the STD group. In conclusion, cardiac resynchronization therapy programming guided by acute noninvasive hemodynamics favored MPP modality and caused short-term LV positive remodeling and improved long-term outcomes. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT04299360.
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Affiliation(s)
- Francesco Passafaro
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Rapacciuolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Antonio Ruocco
- Division of Cardiology, Emergency Department, AORN Cardarelli, Naples, Italy
| | - Giuseppe Ammirati
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Salvatore Crispo
- Division of Cardiology, Emergency Department, AORN Cardarelli, Naples, Italy
| | - Eugenia Pasceri
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Santarpia
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Ciro Mauro
- Division of Cardiology, Emergency Department, AORN Cardarelli, Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health Sciences and Nutrition, University of Calabria, Cosenza, Italy.
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Stoicescu L, Crişan D, Morgovan C, Avram L, Ghibu S. Heart Failure with Preserved Ejection Fraction: The Pathophysiological Mechanisms behind the Clinical Phenotypes and the Therapeutic Approach. Int J Mol Sci 2024; 25:794. [PMID: 38255869 PMCID: PMC10815792 DOI: 10.3390/ijms25020794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is an increasingly frequent form and is estimated to be the dominant form of HF. On the other hand, HFpEF is a syndrome with systemic involvement, and it is characterized by multiple cardiac and extracardiac pathophysiological alterations. The increasing prevalence is currently reaching epidemic levels, thereby making HFpEF one of the greatest challenges facing cardiovascular medicine today. Compared to HF with reduced ejection fraction (HFrEF), the medical attitude in the case of HFpEF was a relaxed one towards the disease, despite the fact that it is much more complex, with many problems related to the identification of physiopathogenetic mechanisms and optimal methods of treatment. The current medical challenge is to develop effective therapeutic strategies, because patients suffering from HFpEF have symptoms and quality of life comparable to those with reduced ejection fraction, but the specific medication for HFrEF is ineffective in this situation; for this, we must first understand the pathological mechanisms in detail and correlate them with the clinical presentation. Another important aspect of HFpEF is the diversity of patients that can be identified under the umbrella of this syndrome. Thus, before being able to test and develop effective therapies, we must succeed in grouping patients into several categories, called phenotypes, depending on the pathological pathways and clinical features. This narrative review critiques issues related to the definition, etiology, clinical features, and pathophysiology of HFpEF. We tried to describe in as much detail as possible the clinical and biological phenotypes recognized in the literature in order to better understand the current therapeutic approach and the reason for the limited effectiveness. We have also highlighted possible pathological pathways that can be targeted by the latest research in this field.
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Affiliation(s)
- Laurențiu Stoicescu
- Internal Medicine Department, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (L.S.); or (D.C.); or (L.A.)
- Cardiology Department, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Dana Crişan
- Internal Medicine Department, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (L.S.); or (D.C.); or (L.A.)
- Internal Medicine Department, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Claudiu Morgovan
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
| | - Lucreţia Avram
- Internal Medicine Department, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (L.S.); or (D.C.); or (L.A.)
- Internal Medicine Department, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Steliana Ghibu
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
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Højgaard EV, Philbert BT, Linde JJ, Winsløw UC, Svendsen JH, Vinther M, Risum N. Efficacy on resynchronization and longitudinal contractile function comparing His-bundle pacing with conventional biventricular pacing: a substudy to the His-alternative study. Eur Heart J Cardiovasc Imaging 2023; 25:66-74. [PMID: 37490036 DOI: 10.1093/ehjci/jead181] [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: 12/20/2022] [Revised: 03/30/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
AIMS His-bundle pacing has emerged as a novel method to deliver cardiac resynchronization therapy (CRT). However, there are no data comparing conventional biventricular (BiV)-CRT with His-CRT with regard to effects on mechanical dyssynchrony and longitudinal contractile function. METHODS AND RESULTS Patients with symptomatic heart failure, left ventricular ejection fraction ≤ 35%, and left bundle branch block (LBBB) by strict ECG criteria were randomized 1:1 to His-CRT or BiV-CRT. Two-dimensional strain echocardiography was performed prior to CRT implantation and at 6 months after implantation. Differences in changes in mechanical dyssynchrony (standard deviation of time-to-peak in 12 midventricular and basal segments) and regional longitudinal strain in the six left ventricular walls were compared between the BiV-CRT and His-CRT groups.In the on-treatment analysis, 31 received BiV-CRT and 19 His-CRT. In both groups, mechanical dyssynchrony was significantly reduced after 6 months [BiV group from 120 ms (±45) to 63 ms (±22), P < 0.001, and His group from 116 ms (±54) to 49 ms (±11), P < 0.001] but no significant differences in changes could be demonstrated between groups [-9.0 ms (-36; 18), P = 0.50]. Global longitudinal strain (GLS) improved in both groups [BiV group from -9.1% (±2.7) to -10.7% (±2.6), P = 0.02, and His group from -8.6% (±2.1) to -11.1% (±2.0), P < 0.001], but no significant differences in changes could be demonstrated from baseline to follow-up [-0.9% (-2.4; -0.6), P = 0.25] between groups. There were no regional differences between groups. CONCLUSION In heart failure, patients with LBBB, BiV-CRT, and His-CRT have comparable effects with regard to improvements in mechanical dyssynchrony and longitudinal contractile function.
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Affiliation(s)
- E V Højgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - B T Philbert
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J J Linde
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - U C Winsløw
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J H Svendsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Vinther
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N Risum
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Winsløw U, Sakthivel T, Zheng C, Philbert B, Vinther M, Frandsen E, Iversen K, Bundgaard H, Jøns C, Risum N. The effect of increased plasma potassium on myocardial function; a randomized POTCAST substudy. Int J Cardiovasc Imaging 2023; 39:2097-2106. [PMID: 37470856 PMCID: PMC10673982 DOI: 10.1007/s10554-023-02914-x] [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: 02/05/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
Plasma potassium (p-K) in the high-normal range has been suggested to reduce risk of cardiovascular arrythmias and mortality through electrophysiological and mechanical effects on the myocardium. In this study, it was to investigated if increasing p-K to high-normal levels improves systolic- and diastolic myocardial function in patients with low-normal to moderately reduced left ventricular ejection fraction (LVEF). The study included 50 patients (mean age 58 years (SD 14), 81% men), with a mean p-K 3.95 mmol/l (SD 0.19), mean LVEF 48% (SD 7), and mean Global Longitudinal Strain (GLS) -14.6% (SD 3.1) patients with LVEF 35-55% from "Targeted potassium levels to decrease arrhythmia burden in high-risk patients with cardiovascular diseases trial" (POTCAST). Patients were given standard therapy and randomized (1:1) to an intervention that included guidance on potassium-rich diets, potassium supplements, and mineralocorticoid receptor antagonists targeting high-normal p-K levels (4.5-5.0 mmol/l). Echocardiography was done at baseline and after a mean follow-up of 44 days (SD 18) and the echocardiograms were analyzed for changes in GLS, mechanical dispersion, E/A, e', and E/e'. At follow-up, mean difference in changes in p-K was 0.52 mmol/l (95%CI 0.35;0.69), P<0.001 in the intervention group compared to controls. GLS was improved with a mean difference in changes of -1.0% (-2;-0.02), P<0.05 and e' and E/e' were improved with a mean difference in changes of 0.9 cm/s (0.02;1.7), P = 0.04 and ? 1.5 (-2.9;-0.14), P = 0.03, respectively. Thus, induced increase in p-K to the high-normal range improved indices of systolic and diastolic function in patients with low-normal to moderately reduced LVEF.
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Affiliation(s)
- Ulrik Winsløw
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Tharsika Sakthivel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Chaoqun Zheng
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Berit Philbert
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Michael Vinther
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Emil Frandsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Pola K, Roijer A, Borgquist R, Ostenfeld E, Carlsson M, Bakos Z, Arheden H, Arvidsson PM. Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy. J Cardiovasc Magn Reson 2023; 25:45. [PMID: 37620886 PMCID: PMC10463519 DOI: 10.1186/s12968-023-00955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT. METHODS Patients with heart failure, EF < 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier-Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole. Transthoracic echocardiography was performed before and 6 months after CRT. Patients with end-systolic volume reduction ≥ 15% were defined as responders. RESULTS Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (0.06 [0.03] vs. 0.07 [0.03], p = 0.04), and in the apex-base direction in diastole (0.09 [0.02] vs. 0.1 [0.05], p = 0.047). Non-responders had larger diastolic HDF ratio compared to responders (0.89 vs. 0.67, p = 0.004). ROC analysis of diastolic HDF ratio for identifying CRT non-responders had AUC of 0.88 (p = 0.005) with sensitivity 57% and specificity 100% for ratio > 0.87. Intragroup comparison found higher HDF ratio in systole compared to diastole for responders (p = 0.003), but not for non-responders (p = 0.8). CONCLUSION Hemodynamic force ratio is a potential marker for identifying patients with heart failure and LBBB who are unlikely to benefit from CRT. Larger-scale studies are required before implementation of HDF analysis into clinical practice.
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Affiliation(s)
- Karin Pola
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Roijer
- Heart Failure and Valvular Heart Disease Section, Skåne University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Zoltan Bakos
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Per M Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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Hopman LHGA, Zweerink A, van der Lingen ALCJ, Huntelaar MJ, Mulder MJ, Robbers LFHJ, van Rossum AC, van Halm VP, Götte MJW, Allaart CP. Feasibility of CMR Imaging during Biventricular Pacing: Comparison with Invasive Measurement as a Pathway towards a Novel Optimization Strategy. J Clin Med 2023; 12:3998. [PMID: 37373691 PMCID: PMC10298880 DOI: 10.3390/jcm12123998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This prospective pilot study assessed the feasibility of cardiovascular magnetic resonance (CMR) imaging during biventricular (BIV) pacing in patients with a CMR conditional cardiac resynchronization therapy defibrillator (CRT-D) and compared the results with invasive volume measurements. METHODS Ten CRT-D patients underwent CMR imaging prior to device implantation (baseline) and six weeks after device implantation, including CRT-on and CRT-off modes. Left ventricular (LV) function, volumes, and strain measurements of LV dyssynchrony and dyscoordination were assessed. Invasive pressure-volume measurements were performed, matching the CRT settings used during CMR. RESULTS Post-implantation imaging enabled reliable cine assessment, but showed artefacts on late gadolinium enhancement images. After six weeks of CRT, significant reverse remodeling was observed, with a 22.7 ± 11% reduction in LV end-systolic volume during intrinsic rhythm (CRT-off). During CRT-on, the LV ejection fraction significantly improved from 27.4 ± 5.9% to 32.2 ± 8.7% (p < 0.01), and the strain assessment showed the abolition of the left bundle branch block contraction pattern. Invasively measured and CMR-assessed LV hemodynamics during BIV pacing were significantly associated. CONCLUSIONS Post-CRT implantation CMR assessing acute LV pump function is feasible and provides important insights into the effects of BIV pacing on cardiac function and contraction patterns. LV assessment during CMR may constitute a future CRT optimization strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; (L.H.G.A.H.)
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Osca J, Francisco-Pascual J, Martínez-Basterra J, Martínez JG, Reis H, Oliveira M, Campos B, Balaguer J, Rubio J, Pavón-Jiménez R, Hernández J, Ormaetxe JM, Zamorano JL, Santamaría P, Alzueta J. Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III. Eur J Clin Invest 2023; 53:e13935. [PMID: 36504276 DOI: 10.1111/eci.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.
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Affiliation(s)
- Joaquín Osca
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Jaume Francisco-Pascual
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | | | | | | | | | - Bieito Campos
- Hospital Universitari Arnau de Vilanova de Lleida, Barcelona, Spain
| | - Javier Balaguer
- Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | - Jerónimo Rubio
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Julio Hernández
- Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Jiang D, Zhang S, Zhang Y, Lv J, Yi Y, Wang J, Wang Y, Yang X, Zhang J, Han B. Predictors and long-term outcomes of heart block after transcatheter device closure of perimembranous ventricular septal defect. Front Cardiovasc Med 2022; 9:1041852. [DOI: 10.3389/fcvm.2022.1041852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHeart block is the most common and concerning complication associated with transcatheter device closure of perimembranous ventricular septal defect (pmVSD) and its occurrence remains a great challenge for device closure.MethodsBetween June 2002 and June 2020, 1076 pediatric patients with pmVSD, who successfully underwent transcatheter device closure in our center, were enrolled in this cohort study, with a median follow-up of 64 months (range: 1 to 19 years).ResultsOf 1076 patients, 234 (21.8%) developed postprocedural heart block, with right bundle branch block being the most common (74.8%), followed by left bundle branch block (16.2%), and atrioventricular block (5.6%). Complete atrioventricular block occurred in 5 cases, including 3 cases with permanent pacemaker implantation, 1 case with recovery to normal sinus rhythm, and 1 case with sudden cardiac death. Most patients (97.9%) developed heart block within 1 week of procedure. Finally, 138 cases returned to normal cardiac conduction. Multivariate logistic regression revealed that thin-waist occluders (odds ratio [OR]: 1.759; 95% confidence interval [CI]: 1.023 to 3.022; P = 0.041), and oversized devices (OR: 1.809; 95% CI: 1.322 to 2.476; P < 0.001) were independently associated with occurrence of postprocedural heart block. Moreover, heart block was less likely to occur when the left disk of occluder was placed within the aneurysmal tissue (OR: 0.568; 95% CI: 0.348 to 0.928; P = 0.024).ConclusionThe outcome of postprocedural heart block is favorable in most cases. Oversized devices and thin-waist occluders should be avoided. Placement of the left disk of the device should into the aneurysmal tissue is highly recommended.
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Petersen A, Nagel SN, Hamm B, Elgeti T, Schaafs LA. Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging. Front Cardiovasc Med 2022; 9:977414. [PMID: 36337885 PMCID: PMC9631472 DOI: 10.3389/fcvm.2022.977414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Left bundle branch block (LBBB) is a ventricular conduction delay with high prevalence. Aim of our study is to identify possible recurring patterns of artefacts in late gadolinium enhancement (LGE) imaging in patients with LBBB who undergo cardiac magnetic resonance imaging (MRI) and to define parameters of mechanical dyssynchrony associated with artefacts in LGE images. Materials and methods Fifty-five patients with LBBB and 62 controls were retrospectively included. Inversion time (TI) scout and LGE images were reviewed for artefacts. Dyssynchrony was identified using cardiac MRI by determining left ventricular systolic dyssynchrony indices (global, septal segments, and free wall segments) derived from strain analysis and features of mechanical dyssynchrony (apical rocking and septal flash). Results Thirty-seven patients (67%) with LBBB exhibited inhomogeneous myocardial nulling in TI scout images. Among them 25 (68%) patients also showed recurring artefact patterns in the septum or free wall on LGE images and artefacts also persisted in 18 (72%) of those cases when utilising phase sensitive inversion recovery. Only the systolic dyssynchrony index of septal segments allowed differentiation of patient subgroups (artefact/no artefact) and healthy controls (given as median, median ± interquartile range); LBBB with artefact: 10.44% (0.44–20.44%); LBBB without artefact: 6.82% (-2.18–15.83%); controls: 4.38% (1.38–7.38%); p < 0.05 with an area under the curve of 0.863 (81% sensitivity, 89% specificity). Septal flash and apical rocking were more frequent in the LBBB with artefact group than in the LBBB without artefact group (70 and 62% versus 33 and 17%; p < 0.05). Conclusion Patients with LBBB show recurring artefact patterns in LGE imaging. Use of strain analysis and evaluation of mechanical dyssynchrony may predict the occurrence of such artefacts already during the examination and counteract misinterpretation.
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Khan Z, Besis G, Tomson J. Worsening Heart Failure and Atrial Flutter in a Patient Secondary to Cardiac Resynchronization Therapy Dyssynchrony: A Case Report. Cureus 2022; 14:e29096. [PMID: 36258951 PMCID: PMC9572945 DOI: 10.7759/cureus.29096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
Cardiac resynchronization therapy-defibrillator (CRT-D) and/or cardiac resynchronization therapy-pacemaker (CRT-P) play an important role in improving cardiac synchronization and reducing the risk of ventricular fibrillation arrest (VFA) in patients with severe left ventricular systolic dysfunction (LVSD). Patients with LVSD may notice worsening symptoms when CRT-D or CRT-P is in dyssynchrony. We present a case of 59-year-old patient who presented with worsening shortness of breath (SOB) and progressive exertional dyspnea for the past few weeks accompanied by pink, frothy sputum, occasional urinary incontinence and urge. He was known to have severe LVSD with an ejection fraction of 10% and had CRT-D in situ. Clinical examination revealed bilateral crepitation and normal heart sounds. A chest radiograph showed pulmonary oedema. An electrocardiogram (ECG) showed atrial fibrillation (AF)/flutter with wide QRS complexes. The patient was treated for acute pulmonary oedema and had CRT-D reprogrammed to achieve biventricular synchrony. He was treated with intravenous furosemide and alternate day metolazone initially. He showed significant subjective and objective improvement and was planned for outpatient synchronized intra-device cardioversion. This case is important because patients with severe LVSD with malfunctioning cardiac resynchronization therapy can result in worsening heart failure (HF) leading to higher morbidity and mortality.
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Stassen J, Galloo X, Chimed S, Hirasawa K, Marsan NA, Delgado V, van der Bijl P, Bax JJ. OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:730-740. [PMID: 35213709 PMCID: PMC9291382 DOI: 10.1093/ehjci/jeac042] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Cardiology, Jessa Hospital, 3500 Hasselt, Belgium
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
| | - Surenjav Chimed
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Corresponding author. Tel: +31 31 71 526 2020; Fax: +31 +31 71 526 6809. E-mail:
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Zhao X, Liu S, Wang X, Chen Y, Pang P, Yang Q, Lin J, Deng S, Wu S, Fan G, Wang B. Diabetic cardiomyopathy: Clinical phenotype and practice. Front Endocrinol (Lausanne) 2022; 13:1032268. [PMID: 36568097 PMCID: PMC9767955 DOI: 10.3389/fendo.2022.1032268] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetic cardiomyopathy (DCM) is a pathophysiological condition of cardiac structure and function changes in diabetic patients without coronary artery disease, hypertension, and other types of heart diseases. DCM is not uncommon in people with diabetes, which increases the risk of heart failure. However, the treatment is scarce, and the prognosis is poor. Since 1972, one clinical study after another on DCM has been conducted. However, the complex phenotype of DCM still has not been fully revealed. This dilemma hinders the pace of understanding the essence of DCM and makes it difficult to carry out penetrating clinical or basic research. This review summarizes the literature on DCM over the last 40 years and discusses the overall perspective of DCM, phase of progression, potential clinical indicators, diagnostic and screening criteria, and related randomized controlled trials to understand DCM better.
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Affiliation(s)
- Xudong Zhao
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shengwang Liu
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Xiao Wang
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Yibing Chen
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Pai Pang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Qianjing Yang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Jingyi Lin
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shuaishuai Deng
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shentao Wu
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Guanwei Fan
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Bin Wang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
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13
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Wouters PC, Leenders GE, Cramer MJ, Meine M, Prinzen FW, Doevendans PA, De Boeck BWL. Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy. Int J Cardiovasc Imaging 2021; 37:1903-1911. [PMID: 33547623 PMCID: PMC8255256 DOI: 10.1007/s10554-021-02174-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. METHODS In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. RESULTS CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. CONCLUSION Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.
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Affiliation(s)
- Philippe C Wouters
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Geert E Leenders
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Maarten J Cramer
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Mathias Meine
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Frits W Prinzen
- Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | | | - Bart W L De Boeck
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.,Luzerner Kantonsspital, 6000, Luzern, Switzerland
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14
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Orszulak M, Filipecki A, Wrobel W, Berger-Kucza A, Orszulak W, Urbanczyk-Swic D, Kwasniewski W, Mizia-Stec K. Left ventricular global longitudinal strain in predicting CRT response: one more J-shaped curve in medicine. Heart Vessels 2021; 36:999-1008. [PMID: 33550426 PMCID: PMC8175293 DOI: 10.1007/s00380-021-01770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/08/2021] [Indexed: 11/20/2022]
Abstract
The aim of the study was: (1) to verify the hypothesis that left ventricular global longitudinal strain (LVGLS) may be of additive prognostic value in prediction CRT response and (2) to obtain such a LVGLS value that in the best optimal way enables to characterize potential CRT responders. Forty-nine HF patients (age 66.5 ± 10 years, LVEF 24.9 ± 6.4%, LBBB 71.4%, 57.1% ischemic aetiology of HF) underwent CRT implantation. Transthoracic echocardiography was performed prior to and 15 ± 7 months after CRT implantation. Speckle-tracking echocardiography was performed to assess longitudinal left ventricular function as LVGLS. The response to CRT was defined as a ≥ 15% reduction in the left ventricular end-systolic volume (∆LVESV). Thirty-six (73.5%) patients responded to CRT. There was no linear correlation between baseline LVGLS and ∆LVESV (r = 0.09; p = 0.56). The patients were divided according to the percentile of baseline LVGLS: above 80th percentile; between 80 and 40th percentile; below 40th percentile. Two peripheral groups (above 80th and below 40th percentile) formed “peripheral LVGLS” and the middle group was called “mid-range LVGLS”. The absolute LVGLS cutoff values were − 6.07% (40th percentile) and − 8.67% (80th percentile). For the group of 20 (40.8%) “mid-range LVGLS” patients mean ΔLVESV was 33.3 ± 16.9% while for “peripheral LVGLS” ΔLVESV was 16.2 ± 18.8% (p < 0.001). Among non-ischemic HF etiology, all “mid-range LVGLS” patients (100%) responded positively to CRT (in “peripheral LVGLS”—55% responders; p = 0.015). Baseline LVGLS may have a potential prognostic value in prediction CRT response with relationship of inverted J-shaped pattern. “Mid-range LVGLS” values should help to select CRT responders, especially in non-ischemic HF etiology patients.
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Affiliation(s)
- Michal Orszulak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland.
| | - Artur Filipecki
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Wojciech Wrobel
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Adrianna Berger-Kucza
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Witold Orszulak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Dagmara Urbanczyk-Swic
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Wojciech Kwasniewski
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
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15
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Singh A, Karnik R, Shah AN, Chutani S, Kantharia BK. Myocardial strain characteristics at different interventricular pacing timings: implications for device programming and long-term clinical outcomes in patients with cardiac resynchronisation therapy. Acta Cardiol 2021; 76:46-55. [PMID: 31725350 DOI: 10.1080/00015385.2019.1690261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS Response to cardiac resynchronisation therapy (CRT) in patients with heart failure depends on the degree of correction of electromechanical dyssynchrony between the left and right ventricles (LV, RV). It is not known whether chronic programming of interventricular (VV) intervals based on characterisation of myocardial strain at different pacing intervals performed acutely would have better long-term clinical outcomes. We hence aimed to evaluate this relationship between speckle tracking strain patterns and rates at different VV intervals and long-term clinical outcomes of programmed VV pacing in patients with CRT in a prospective, longitudinal follow-up study. METHODS We assessed echocardiographic effects, myocardial strain patterns and rates in acute settings at VV intervals; 'LV Off', 'VV0', 'VV60' and 'RV Off' to provide 'RV-only', 'simultaneous BiV', 'sequential LV-RV' and 'LV-only' pacing respectively in 338 patients (age, 67.5 ± 10.3 years; male, 70%) with CRT. Thereafter, devices were programmed chronically to VV60, and long-term clinical outcomes were assessed. RESULTS With VV0, VV60 and LV only pacing, LVEF improved to 33.6 ± 12.3%, 40.0 ± 11.4% and 42.6 ± 11.2%, respectively, from 23.7 ± 10.2% at baseline (p < .001). Incremental improvement in strain occurred with VV0, VV60 and LV only pacing; greatest with LV only pacing. At 1 year, 23% patients had NYHA III-IV compared to 96% at baseline (p < .001). CONCLUSIONS In patients with CRT, different VV timings show significant differences in acute myocardial strain patterns and rates, and LVEF. These changes are markedly favourable with LV-only and sequential LV-RV pacing, the latter with chronic programming also results in long-term clinical improvement.
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Affiliation(s)
- Amarnauth Singh
- Phoenix Heart Cardiovascular Consultants, Banner Thunderbird Medical Center, Glendale, AR, USA
| | - Rahool Karnik
- Phoenix Heart Cardiovascular Consultants, Banner Thunderbird Medical Center, Glendale, AR, USA
| | - Arti N. Shah
- Cardiovascular and Heart Rhythm Consultants, New York, NY, USA
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16
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Biering-Sørensen T, Minamisawa M, Claggett B, Liu J, Felker GM, McMurray JJ, Malik FI, Abbasi S, Kurtz CE, Teerlink JR, Solomon SD. Cardiac Myosin Activator Omecamtiv Mecarbil Improves Left Ventricular Myocardial Deformation in Chronic Heart Failure. Circ Heart Fail 2020; 13:e008007. [DOI: 10.1161/circheartfailure.120.008007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tor Biering-Sørensen
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (T.B.-S., M.M., B.C., J.L., S.D.S.)
- Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S.), University of Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences (T.B.-S.), University of Copenhagen, Denmark
| | - Masatoshi Minamisawa
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (T.B.-S., M.M., B.C., J.L., S.D.S.)
- Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan (M.M.)
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (T.B.-S., M.M., B.C., J.L., S.D.S.)
| | - Jiankang Liu
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (T.B.-S., M.M., B.C., J.L., S.D.S.)
| | - G. Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC (G.M.F.)
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.)
| | | | | | | | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco (J.R.T.)
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (T.B.-S., M.M., B.C., J.L., S.D.S.)
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17
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van der Bijl P, Kostyukevich MV, Khidir M, Ajmone Marsan N, Delgado V, Bax JJ. Left ventricular remodelling and change in left ventricular global longitudinal strain after cardiac resynchronization therapy: prognostic implications. Eur Heart J Cardiovasc Imaging 2020; 20:1112-1119. [PMID: 31329827 DOI: 10.1093/ehjci/jez072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/17/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) can reduce left ventricular end-systolic volume (LVESV), and a decrease of ≥15% is defined as a response. CRT can also improve LV global longitudinal strain (GLS). Changes in LVESV and LV GLS are individually associated with outcome post-CRT. We investigated LVESV and LV GLS changes and prognostic implications of improvement in LVESV and/or LV GLS, compared with no improvement in either parameter. METHODS AND RESULTS Baseline and 6-month echocardiograms were analysed from CRT recipients with heart failure. LV reverse remodelling was defined as a ≥15% reduction in LVESV at 6 months post-CRT. A ≥5% absolute improvement in LV GLS was defined as a change in LV GLS. A total of 1185 patients were included (mean age 65 ± 10 years, 73% male), and those with an improvement in LVESV and LV GLS (n = 131, 11.1%) had significantly lower mortality compared with other groups. On multivariable analysis, an improvement in both LVESV and LV GLS [hazard ratio (HR): 0.47; 95% confidence interval (CI): 0.31-0.71; P < 0.001] or an improvement in either LVESV or LV GLS (HR: 0.57; 95% CI: 0.47-0.71; P < 0.001) were independently associated with better prognosis, compared with no improvement in either parameter. CONCLUSION Either a reduction in LVESV and/or an improvement in LV GLS at 6 months post-CRT are independently associated with improved long-term prognosis, compared with no change in both LVESV and LV GLS. This supports the use of LV GLS as a meaningful parameter in defining CRT response.
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Affiliation(s)
- Pieter van der Bijl
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Marina V Kostyukevich
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Mand Khidir
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, RC Leiden, The Netherlands
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18
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Endothelial dysfunction and glycocalyx shedding in heart failure: insights from patients receiving cardiac resynchronisation therapy. Heart Vessels 2019; 35:197-206. [DOI: 10.1007/s00380-019-01481-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
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19
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Olsen FJ, Biering-Sørensen T. Myocardial Strain and Dyssynchrony: Incremental Value? Heart Fail Clin 2019; 15:167-178. [PMID: 30832809 DOI: 10.1016/j.hfc.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Heart failure (HF) has evolved in an epidemic manner and constitutes a major public health issue. Currently, several prognostic markers and treatment options exist to guide treatment of HF with reduced ejection fraction, but echocardiographic deformation imaging suggests novel pathophysiologic aspects that could help optimize treatment further. Even though no formal treatment options currently exist for patients with HF with preserved ejection fraction, some HF medication does seem to attenuate strain measures. Speckle tracking has furthermore helped characterize this condition and to confer prognostic information. Thus, strain imaging could facilitate novel trials, and thereby hopefully introduce treatment opportunities.
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Affiliation(s)
- Flemming J Olsen
- Gentofte Hospital, Department of Cardiology, Niels Andersens Vej 65, Hellerup 2900, Denmark
| | - Tor Biering-Sørensen
- Gentofte Hospital, Department of Cardiology, Niels Andersens Vej 65, Hellerup 2900, Denmark.
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20
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Poulidakis E, Aggeli C, Sideris S, Sfendouraki E, Koutagiar I, Katsaros A, Giannoulis E, Koukos M, Margioula E, Lagoudakou S, Gatzoulis K, Dilaveris P, Kallikazaros I, Couloheri S, Stefanadis C, Tousoulis D. Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices. Int J Cardiovasc Imaging 2019; 35:285-294. [PMID: 30623352 DOI: 10.1007/s10554-018-01520-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/24/2018] [Indexed: 12/28/2022]
Abstract
Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2-4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.
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Affiliation(s)
- Emmanouil Poulidakis
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece.
- Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Constantina Aggeli
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Skevos Sideris
- Cardiology Department, Hippokration Hospital, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Eliza Sfendouraki
- Cardiology Department, Hippokration Hospital, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Iosif Koutagiar
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Andreas Katsaros
- Cardiosurgery Department, Hippokration Hospital, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Evangelos Giannoulis
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece
| | - Markos Koukos
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece
| | - Eleni Margioula
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece
| | - Stavroula Lagoudakou
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Kostas Gatzoulis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Polychronis Dilaveris
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Ioannis Kallikazaros
- Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece
| | - Stavroula Couloheri
- Department of Biological Chemistry, Medical School, University of Athens, 75 M. Asias st, 115 27, Athens, Greece
| | - Christodoulos Stefanadis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece
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21
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Kutyifa V, Vermilye K, Solomon SD, McNitt S, Moss AJ, Daimee UA. Long-term outcomes of cardiac resynchronization therapy by left ventricular ejection fraction. Eur J Heart Fail 2018; 21:360-369. [PMID: 30592353 DOI: 10.1002/ejhf.1357] [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] [Received: 07/12/2018] [Revised: 09/10/2018] [Accepted: 10/11/2018] [Indexed: 11/09/2022] Open
Abstract
AIMS Despite our prior report suggesting heart failure (HF) risk reduction from cardiac resynchronization therapy with defibrillator (CRT-D) in mild HF patients with higher left ventricular ejection fraction (LVEF > 30%), data on mortality benefit in this cohort are lacking. We aimed to assess long-term mortality benefit from CRT-D in mild HF patients by LVEF > 30%. METHODS AND RESULTS Among 1274 patients with mild HF and left bundle branch block enrolled in MADIT-CRT, we analysed long-term effects of CRT-D vs. implantable cardioverter defibrillator (ICD) therapy only, and reverse remodelling to CRT-D (left ventricular end-systolic volume percent change ≥ median at 1 year), on all-cause mortality and HF for the LVEF ≤ 30% and LVEF > 30 subgroups using Kaplan-Meier and Cox analyses. During long-term follow-up, CRT-D vs. ICD was associated with reduction in all-cause mortality in both patients with LVEF > 30% and LVEF ≤ 30% [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.25-0.85, P = 0.036 vs. HR 0.69, 95% CI 0.49-0.98, P = 0.013, interaction P = 0.261]. The efficacy of CRT-D vs. ICD only to reduce HF was similar in those with LVEF above and below 30% (HR 0.36, 95% CI 0.35-0.61, P < 0.001 vs. HR 0.46, 95% CI 0.35-0.61, P < 0.001; interaction P = 0.342). Patients with CRT-D-induced reverse remodelling had significant mortality reduction when compared to ICD, with either LVEF > 30% or LVEF ≤ 30% (HR 0.17 and 0.39), but no mortality benefit was seen in patients with less reverse remodelling. HF events, however, were reduced in both CRT-D-induced high and low reverse remodelling vs. ICD only, in both LVEF subgroups. CONCLUSIONS In MADIT-CRT, left bundle branch block patients with higher LVEF (> 30%) derive long-term mortality benefit from CRT-D when exhibiting significant reverse remodelling. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID NCT00180271, NCT01294449, and NCT02060110.
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Affiliation(s)
| | | | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott McNitt
- University of Rochester Medical Center, Rochester, NY, USA
| | - Arthur J Moss
- University of Rochester Medical Center, Rochester, NY, USA
| | - Usama A Daimee
- University of Rochester Medical Center, Rochester, NY, USA
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22
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Arvidsson PM, Töger J, Pedrizzetti G, Heiberg E, Borgquist R, Carlsson M, Arheden H. Hemodynamic forces using four-dimensional flow MRI: an independent biomarker of cardiac function in heart failure with left ventricular dyssynchrony? Am J Physiol Heart Circ Physiol 2018; 315:H1627-H1639. [DOI: 10.1152/ajpheart.00112.2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patients with heart failure with left ventricular (LV) dyssynchrony often do not respond to cardiac resynchronization therapy (CRT), indicating that the pathophysiology is insufficiently understood. Intracardiac hemodynamic forces computed from four-dimensional (4-D) flow MRI have been proposed as a new measure of cardiac function. We therefore aimed to investigate how hemodynamic forces are altered in LV dyssynchrony. Thirty-one patients with heart failure and LV dyssynchrony and 39 control subjects underwent cardiac MRI with the acquisition of 4-D flow. Hemodynamic forces were computed using Navier-Stokes equations and integrated over the manually delineated LV volume. The ratio between transverse (lateral-septal and inferior-anterior) and longitudinal (apical-basal) forces was calculated for systole and diastole separately and compared with QRS duration, aortic valve opening delay, global longitudinal strain, and ejection fraction (EF). Patients exhibited hemodynamic force patterns that were significantly altered compared with control subjects, including loss of longitudinal forces in diastole (force ratio, control subjects vs. patients: 0.32 vs. 0.90, P < 0.0001) and increased transverse force magnitudes. The systolic force ratio was correlated with global longitudinal strain and EF ( P < 0.01). The diastolic force ratio separated patients from control subjects (area under the curve: 0.98, P < 0.0001) but was not correlated to other dyssynchrony measures ( P > 0.05 for all). Hemodynamic forces by 4-D flow represent a new approach to the quantification of LV dyssynchrony. Diastolic force patterns separate healthy from diseased ventricles. Different force patterns in patients indicate the possible use of force analysis for risk stratification and CRT implantation guidance. NEW & NOTEWORTHY In this report, we demonstrate that patients with heart failure with left ventricular dyssynchrony exhibit significantly altered hemodynamic forces compared with normal. Force patterns in patients mechanistically reflect left ventricular dysfunction on the organ level, largely independent of traditional dyssynchrony measures. Force analysis may help clinical decision making and could potentially be used to improve therapy outcomes.
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Affiliation(s)
- Per M. Arvidsson
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Johannes Töger
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Einar Heiberg
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Faculty of Engineering, Lund, Sweden
| | - Rasmus Borgquist
- Lund University, Department of Cardiology, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Håkan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
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23
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Zweerink A, van Everdingen WM, Nijveldt R, Salden OAE, Meine M, Maass AH, Vernooy K, de Lange FJ, Vos MA, Croisille P, Clarysse P, Geelhoed B, Rienstra M, van Gelder IC, van Rossum AC, Cramer MJ, Allaart CP. Strain imaging to predict response to cardiac resynchronization therapy: a systematic comparison of strain parameters using multiple imaging techniques. ESC Heart Fail 2018; 5:1130-1140. [PMID: 30051598 PMCID: PMC6300826 DOI: 10.1002/ehf2.12335] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/15/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Various strain parameters and multiple imaging techniques are presently available including cardiovascular magnetic resonance (CMR) tagging (CMR‐TAG), CMR feature tracking (CMR‐FT), and speckle tracking echocardiography (STE). This study aims to compare predictive performance of different strain parameters and evaluate results per imaging technique to predict cardiac resynchronization therapy (CRT) response. Methods and results Twenty‐seven patients were prospectively enrolled and underwent CMR and echocardiographic examination before CRT implantation. Strain analysis was performed in circumferential (CMR‐TAG, CMR‐FT, and STE‐circ) and longitudinal (STE‐long) orientations. Regional strain values, parameters of dyssynchrony, and discoordination were calculated. After 12 months, CRT response was measured by the echocardiographic change in left ventricular (LV) end‐systolic volume (LVESV). Twenty‐six patients completed follow‐up; mean LVESV change was −29 ± 27% with 17 (65%) patients showing ≥15% LVESV reduction. Measures of dyssynchrony (SD‐TTPLV) and discoordination (ISFLV) were strongly related to CRT response when using CMR‐TAG (R2 0.61 and R2 0.57, respectively), but showed poor correlations for CMR‐FT and STE (all R2 ≤ 0.32). In contrast, the end‐systolic septal strain (ESSsep) parameter showed a consistent high correlation with LVESV change for all techniques (CMR‐TAG R2 0.60; CMR‐FT R2 0.50; STE‐circ R2 0.43; and STE‐long R2 0.43). After adjustment for QRS duration and QRS morphology, ESSsep remained an independent predictor of response per technique. Conclusions End‐systolic septal strain was the only parameter with a consistent good relation to reverse remodelling after CRT, irrespective of assessment technique. In clinical practice, this measure can be obtained by any available strain imaging technique and provides predictive value on top of current guideline criteria.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Odette A E Salden
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederik J de Lange
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - Pierre Croisille
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Patrick Clarysse
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Bastiaan Geelhoed
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
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24
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Donal E, Delgado V, Magne J, Bucciarelli-Ducci C, Leclercq C, Cosyns B, Sitges M, Edvardsen T, Sade E, Stankovic I, Agricola E, Galderisi M, Lancellotti P, Hernandez A, Plein S, Muraru D, Schwammenthal E, Hindricks G, Popescu BA, Habib G. Rational and design of EuroCRT: an international observational study on multi-modality imaging and cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2018; 18:1120-1127. [PMID: 28329299 DOI: 10.1093/ehjci/jex021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 01/06/2023] Open
Abstract
Aims Assessment of left ventricular (LV) volumes and ejection fraction (LVEF) with cardiac imaging is important in the selection of patients for cardiac resynchronization therapy (CRT). Several observational studies have explored the role of imaging-derived LV dyssynchrony parameters to predict the response to CRT, but have yielded inconsistent results, precluding the inclusion of imaging-derived LV dyssynchrony parameters in current guidelines for selection of patients for CRT. Methods The EuroCRT is a large European multicentre prospective observational study led by the European Association of Cardiovascular Imaging. We aim to explore if combing the value of cardiac magnetic resonance (CMR) and echocardiography could be beneficial for selecting heart failure patients for CRT in terms of improvement in long-term survival, clinical symptoms, LV function, and volumes. Speckle tracking echocardiography will be used to assess LV dyssynchrony and wasted cardiac work whereas myocardial scar will be assessed with late gadolinium contrast enhanced CMR. All data will be measured in core laboratories. The study will be conducted in European centres with known expertise in both CRT and multimodality cardiac imaging.
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Affiliation(s)
- Erwan Donal
- Cardiology, Rennes University Hospital, INSERM 1414 Clinical Investigation Center, Innovative Technology, 2 Rue Henri Le Guilloux, CHU Pontchaillou, Rennes F-35000, France.,LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Cardiologie, Limoges, France.,INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Biomedical Research Unity, University of Bristol, Bristol, UK
| | - Christophe Leclercq
- Cardiology, Rennes University Hospital, INSERM 1414 Clinical Investigation Center, Innovative Technology, 2 Rue Henri Le Guilloux, CHU Pontchaillou, Rennes F-35000, France.,LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France
| | | | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | | | - Ivan Stankovic
- Department of Cardiology, University Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Eustachio Agricola
- Cardiothoracic Department, San Raffaele University Hospital, IRCCS, 20132 Milan, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomeducal Sciences, Federico II University Hospital, Naples, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC), Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds, Clarendon Way, Leeds, UK
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua 35128, Italy
| | | | - Gerhard Hindricks
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Gilbert Habib
- LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France.,Department of Cardiology, Aix-Marseille Université, 13284 Marseille, France
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25
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Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
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26
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Usefulness of Electrocardiographic Left Atrial Abnormality to Predict Response to Cardiac Resynchronization Therapy in Patients With Mild Heart Failure and Left Bundle Branch Block (a Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy Substudy). Am J Cardiol 2018; 122:268-274. [PMID: 29861050 DOI: 10.1016/j.amjcard.2018.03.364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 11/20/2022]
Abstract
Cardiac resynchronization therapy (CRT) has proven prognostic benefits in patients with heart failure (HF) with left bundle branch block (LBBB) QRS morphology. Electrocardiographic left atrial (LA) abnormality has been proposed as a noninvasive marker of atrial remodeling. We aimed to assess the impact of electrocardiographic LA abnormality for prognosis in patients with HF treated with CRT. Baseline resting 12-lead electrocardiograms recorded from 941 patients enrolled in the CRT arm of the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy was processed automatically using Glasgow algorithm, which included automated assessment of P-wave terminal force in lead V1 (PTF-V1) as a marker of LA abnormality. A PTF-V1 of ≥0.04 mm⋅s was considered abnormal. The primary end point was HF event and/or death. Total mortality and appropriate defibrillator therapies were the secondary end points. At baseline 550, patients treated with CRT with a defibrillator had LBBB QRS morphology and normal PTF-V1. Normal PTF-V1 was associated with significant risk reduction for all assessed end points and for the primary end point comprised a hazard ratio of 0.55 (95% confidence interval 0.36 to 0.84) compared with patients with LBBB with abnormal PTF-V1 (n = 120), and a hazard ratio of 0.42 (95% confidence interval 0.32 to 0.55) compared with patients with implanted defibrillator (n = 729). In CRT-treated patients with HF, electrocardiographic LA abnormality appears to be an electrocardiographic indicator of poor long-term outcome in patients with LBBB. In conclusion, our data suggest that PTF-V1 bears additive prognostic information in the context of CRT, thus further strengthening the role of electrocardiographic diagnostics in risk stratification of patients with HF.
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27
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Kumar V. Dyssynchrony: a risk marker for ventricular arrhythmias? J Nucl Cardiol 2018; 25:570-571. [PMID: 29110289 DOI: 10.1007/s12350-017-1103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Vineet Kumar
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, 930 Faculty Office Towers, 510 20th Street South, Birmingham, AL, 35294-0006, USA.
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28
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Khidir MJH, Abou R, Yilmaz D, Ajmone Marsan N, Delgado V, Bax JJ. Prognostic value of global longitudinal strain in heart failure patients treated with cardiac resynchronization therapy. Heart Rhythm 2018; 15:1533-1539. [PMID: 29604420 DOI: 10.1016/j.hrthm.2018.03.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Myocardial fibrosis (macroscopic scar or diffuse reactive fibrosis) is one of the determinants of impaired left ventricular (LV) global longitudinal strain (GLS) in heart failure (HF) patients. OBJECTIVE The purpose of this study was to evaluate the prognostic value of LV GLS in HF patients treated with cardiac resynchronization therapy (CRT). METHODS The study included 829 HF patients (mean age 64.6 ± 10.4 years; 72% men) treated with CRT. Before CRT implantation, LV GLS was assessed using 2-dimensional speckle tracking echocardiography. The primary endpoint was the combination of all-cause mortality, heart transplantation, and LV assist device implantation. The secondary endpoint was the occurrence of ventricular arrhythmias or appropriate implantable defibrillator device therapies. RESULTS During follow-up, 332 patients reached the primary endpoint, and 233 presented with the secondary endpoint. Patients were divided according to LV GLS quartiles. Patients with the most impaired LV GLS quartile had a 2-fold higher risk of reaching the combined endpoint compared with patients in the best LV GLS quartile (hazard ratio [HR] 2.088; 95% confidence interval [CI] 1.555-2.804; P <.001). LV GLS was significantly associated with the combined endpoint (HR 1.075; 95% CI 1.020-1.133; P = .007) after adjusting for clinical, electrocardiographic, and echocardiographic characteristics. Although patients in the most impaired LV GLS quartile showed higher event rates for the secondary endpoint compared with the other groups, LV GLS was not independently associated with the secondary endpoint (HR 1.047; 95% CI 0.989-1.107; P = .115). CONCLUSION In this large cohort of CRT patients, baseline LV GLS was independently associated with the combined endpoint.
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Affiliation(s)
- Mand J H Khidir
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Rachid Abou
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Dilek Yilmaz
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands.
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29
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Right ventricular lead location, right-left ventricular lead interaction, and long-term outcomes in cardiac resynchronization therapy patients. J Interv Card Electrophysiol 2018; 52:185-194. [DOI: 10.1007/s10840-018-0332-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
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30
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Improvement of increased cQTd is associated with heart function in patients with ischemic heart failure. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:41-49. [PMID: 29434624 PMCID: PMC5803536 DOI: 10.11909/j.issn.1671-5411.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Chronic heart failure (CHF) is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate (cQTd) and heart function in patients with CHF. Methods From January 2013 to December 2015, we continuously enrolled 240 patients categorized as New York Heart Association functional class (NYHA) III-IV with a left ventricular ejection fraction (LVEF) < 40%. Based on the etiology, the patients were divided into a dilated cardiomyopathy (DCM) group (n = 120) and an ischemic cardiomyopathy (ICM) group (n = 120). Then, based on the cQTd width, the ICM group was divided into two subgroups: a QS group (cQTd ≤ 60 ms, n = 70) and a QL group (cQTd > 60 ms, n = 50). All patients were examined by echocardiography and 12-lead electrocardiography (ECG) at 1, 3, 6, and 12 months after enrollment. Results After one year of optimized medical treatment, patients in both groups showed significant improvement in LVEF and NYHA classification from baseline. However, the cQTd in the ICM group, especially the QL, was significantly shorter than that in the DCM group at each time point. In addition, the cQTd was negatively correlated with LVEF and 6-min walking test and positively correlated with NYHA class in the ICM group. Conclusions The present findings clearly demonstrate that cQTd is a meaningful parameter for assessing heart function in the follow-up of ICM patients.
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31
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Hwang IC, Cho GY, Yoon YE, Park JJ. Association Between Global Longitudinal Strain and Cardiovascular Events in Patients With Left Bundle Branch Block Assessed Using Two-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2017; 31:52-63.e6. [PMID: 29079044 DOI: 10.1016/j.echo.2017.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prognostic value of left ventricular (LV) global strain and twist in patients with left bundle branch block (LBBB) is not fully investigated. The aim of this study was to investigate the association between myocardial strain and twist and cardiovascular events in patients with LBBB, as assessed using two-dimensional speckle-tracking echocardiography. METHODS A total of 269 patients with LBBB (mean age, 69.5 ± 10.9 years; 46.8% men) were retrospectively identified. Using speckle-tracking, LV global longitudinal strain (GLS), global circumferential strain, and twist were measured. Association between LV global function and a composite of cardiovascular mortality and hospitalization for heart failure was compared with clinical risk factors, LV ejection fraction (LVEF), and other echocardiographic parameters. RESULTS During a median of 27.5 months (interquartile range, 12.8-43.9 months), the composite end point occurred in 55 patients (20.4%). In univariate analyses, diabetes mellitus, chronic kidney disease, ischemic etiology of LBBB, dilated left atrium, reduced LVEF, dilated left ventricle, and impaired LV global strain (GLS > -12.2%, global circumferential strain > -11.8%, and twist < 6.5°) showed associations with the composite end point. In multivariate analyses, GLS was significantly associated with the composite end point (adjusted hazard ratio, 4.697; 95% CI, 1.344-16.413; P = .015), whereas global circumferential strain, twist, and LVEF were not. GLS showed an additive association with poor prognosis over clinical risk factors and other echocardiographic parameters, including LVEF. Patients with preserved LVEFs (≥40%) but impaired GLS (>-12.2%) had a larger number of clinical events than those with impaired LVEFs but preserved GLS. CONCLUSIONS Among patients with LBBB, GLS can provide better risk stratification than LVEF or other echocardiographic parameters.
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Affiliation(s)
- In-Chang Hwang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Yeonyee E Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Zeitler EP, Friedman DJ, Daubert JP, Al-Khatib SM, Solomon SD, Biton Y, McNitt S, Zareba W, Moss AJ, Kutyifa V. Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up. J Am Coll Cardiol 2017; 69:2369-2379. [PMID: 28494974 DOI: 10.1016/j.jacc.2017.03.531] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/26/2017] [Accepted: 03/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data regarding cardiac resynchronization therapy (CRT) in patients with multiple comorbidities are limited. OBJECTIVES This study evaluated the association of multiple comorbidities with the benefits of CRT over implantable cardioverter-defibrillator (ICD) alone. METHODS We examined 1,214 MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) study patients with left bundle branch block (LBBB) and 0, 1, 2, or ≥3 comorbidities, including renal dysfunction, hypertension (HTN), diabetes, coronary artery disease, history of atrial arrhythmias, history of ventricular arrhythmias, current smoking, and cerebrovascular accident. In an adjusted analysis, we analyzed risk of heart failure (HF) events or death by comorbidity group in all patients and in patients with CRT with defibrillator (CRT-D) versus ICD. Then we examined percent change in left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV ejection fraction, left atrial volume, and LV dyssynchrony at 1-year in CRT-D patients by comorbidity group. RESULTS There was an inverse relationship between comorbidity burden and improvements in LV end-systolic volume, LV end-diastolic volume, left ventricular ejection fraction, left atrial volume, and LV dyssynchrony. In an adjusted model, there was an increasing risk of death or nonfatal HF events with increasing comorbidity burden regardless of treatment group (p < 0.001). During a mean follow-up of 4.65 years, there was no interaction with respect to comorbidity burden and the benefit of CRT-D versus ICD only for death or nonfatal HF events (interaction p = 0.943). In the groups with greatest comorbidity burden (2 and ≥3), the absolute risk reduction associated with CRT-D over ICD alone appeared greater than that seen for groups with less comorbidity burden (0 and 1). CONCLUSIONS During long-term follow-up of MADIT-CRT study patients with LBBB randomized to CRT-D, there were differences in HF or death risk and in the degree of reverse remodeling among comorbidity groups. However, the burden of comorbidity does not appear to compromise the clinical benefits of CRT-D compared with ICD alone.
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Affiliation(s)
- Emily P Zeitler
- Cardiology Division, Duke University Hospital and Duke Clinical Research Institute, Durham, North Carolina
| | - Daniel J Friedman
- Cardiology Division, Duke University Hospital and Duke Clinical Research Institute, Durham, North Carolina
| | - James P Daubert
- Cardiology Division, Duke University Hospital and Duke Clinical Research Institute, Durham, North Carolina
| | - Sana M Al-Khatib
- Cardiology Division, Duke University Hospital and Duke Clinical Research Institute, Durham, North Carolina
| | - Scott D Solomon
- Cardiology Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yitschak Biton
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester, Rochester, New York
| | - Scott McNitt
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester, Rochester, New York
| | - Wojciech Zareba
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester, Rochester, New York
| | - Arthur J Moss
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester, Rochester, New York
| | - Valentina Kutyifa
- Heart Research Follow-Up Program, Cardiology Division, University of Rochester, Rochester, New York.
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Qiu Q, Yang L, Mai JT, Yang Y, Xie Y, Chen YX, Wang JF. Acute Effects of Multisite Biventricular Pacing on Dyssynchrony and Hemodynamics in Canines With Heart Failure. J Card Fail 2017; 23:304-311. [DOI: 10.1016/j.cardfail.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 12/13/2016] [Accepted: 01/09/2017] [Indexed: 01/14/2023]
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Biering-Sørensen T, Shah SJ, Anand I, Sweitzer N, Claggett B, Liu L, Pitt B, Pfeffer MA, Solomon SD, Shah AM. Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction. Eur J Heart Fail 2017; 19:1043-1052. [PMID: 28322009 DOI: 10.1002/ejhf.789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 12/24/2022] Open
Abstract
AIMS Left ventricular mechanical dyssynchrony has been described in heart failure with preserved ejection fraction (HFpEF), but its prognostic significance is not known. METHODS AND RESULTS Of 3445 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, dyssynchrony analysis was performed on 424 patients (12%) by multiple speckle tracking echocardiography strain-based criteria. The primary dyssynchrony analysis was the standard deviation of the time to peak longitudinal strain (SD T2P LS). Cox proportional hazards models assessed the association of dyssynchrony with the composite outcome of cardiovascular death or heart failure hospitalization. Mean age was 70 ± 10 years, LVEF was 60 ± 8%, and QRS duration was 101 ± 27 ms. Worse dyssynchrony, reflected in SD T2P LS, was associated with wider QRS, prior myocardial infarction, larger LV volume and mass, and worse systolic (lower LVEF and global longitudinal strain) and diastolic (lower e' and higher E/e') function. During a median follow-up of 2.6 (interquartile range 1.5-3.8) years, 107 patients experienced the composite outcome. Worse dyssynchrony was associated with the composite outcome in unadjusted analysis [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.07; P = 0.021, per 10 ms increase], but not after adjusting for clinical characteristics, or after further adjustment for LVEF, AF, NYHA class, stroke, heart rate, creatinine, haematocrit, and QRS duration (HR 1.03, 95% CI 0.99-1.06; P = 0.16, per 10 ms increase). CONCLUSION Worse LV mechanical dyssynchrony, assessed by speckle tracking echocardiography, is not an independent predictor of adverse outcomes in HFpEF, suggesting that mechanical dyssynchrony is unlikely to be an important mechanism underlying this syndrome. These findings warrant validation in an independent study specifically designed to assess the prognostic utility of mechanical dyssynchrony in HFpEF. TRIAL REGISTRATION NCT00094302.
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Affiliation(s)
- Tor Biering-Sørensen
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Sanjiv J Shah
- Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Inder Anand
- Cardiovascular Division, VA Medical Center, Minneapolis, MN, USA
| | - Nancy Sweitzer
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Li Liu
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Bertram Pitt
- Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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McCanta AC, Perry JC. Cardiac resynchronization therapy in children with heart failure. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Luparelli M, Buccheri D, Corrado E, Ajello L, Bentivegna R, Ciaramitaro G, Assennato P, Coppola G. The importance of being “responder” in cardiac resynchronization therapy. Int J Cardiol 2016; 223:838-841. [DOI: 10.1016/j.ijcard.2016.08.159] [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: 07/16/2016] [Accepted: 08/07/2016] [Indexed: 10/21/2022]
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To ACY, Benatti RD, Sato K, Grimm RA, Thomas JD, Wilkoff BL, Agler D, Popović ZB. Strain-time curve analysis by speckle tracking echocardiography in cardiac resynchronization therapy: Insight into the pathophysiology of responders vs. non-responders. Cardiovasc Ultrasound 2016; 14:14. [PMID: 27090784 PMCID: PMC4835914 DOI: 10.1186/s12947-016-0057-4] [Citation(s) in RCA: 9] [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: 03/09/2016] [Accepted: 04/08/2016] [Indexed: 11/17/2022] Open
Abstract
Background Patients with non-ischemic heart failure etiology and left bundle branch block (LBBB) show better response to cardiac resynchronization therapy (CRT). While these patients have the most pronounced left ventricular (LV) dyssynchrony, LV dyssynchrony assessment often fails to predict outcome. We hypothesized that patients with favorable outcome from CRT can be identified by a characteristic strain distribution pattern. Methods From 313 patients who underwent CRT between 2003 and 2006, we identified 10 patients who were CRT non-responders (no LV end-systolic volume [LVESV] reduction) with non-ischemic cardiomyopathy and LBBB and compared with randomly selected CRT responders (n = 10; LVESV reduction ≥15 %). Longitudinal strain (εlong) data were obtained by speckle tracking echocardiography before and after (9 ± 5 months) CRT implantation and standardized segmental εlong-time curves were obtained by averaging individual patients. Results In responders, ejection fraction (EF) increased from 25 ± 9 to 40 ± 11 % (p = 0.002), while in non-responders, EF was unchanged (20 ± 8 to 21 ± 5 %, p = 0.57). Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT. Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction. Restoration of contraction synchrony was observed in both groups, though non-responder remained low amplitude of εlong. Conclusions CRT non-responders with LBBB and non-ischemic etiology showed a similar improvement of εlong pattern with responders after CRT implantation, while amplitude of εlong remained unchanged. Lower εlong in the non-responders may account for their poor response to CRT.
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Affiliation(s)
- Andrew C Y To
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.,Department of Cardiology, North Shore Hospital, 124 Shakespeare Rd, Takapuna, Auckland, New Zealand
| | - Rodolfo D Benatti
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Kimi Sato
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - James D Thomas
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Bruce L Wilkoff
- Section of Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Deborah Agler
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Zoran B Popović
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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Pedrizzetti G, Martiniello AR, Bianchi V, D'Onofrio A, Caso P, Tonti G. Changes in electrical activation modify the orientation of left ventricular flow momentum: novel observations using echocardiographic particle image velocimetry. Eur Heart J Cardiovasc Imaging 2016; 17:203-9. [PMID: 26060201 PMCID: PMC4882880 DOI: 10.1093/ehjci/jev137] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIMS Changes in electrical activation sequence are known to affect the timing of cardiac mechanical events. We aim to demonstrate that these also modify global properties of the intraventricular blood flow pattern. We also explore whether such global changes present a relationship with clinical outcome. METHODS AND RESULTS We investigated 30 heart failure patients followed up after cardiac resynchronization therapy (CRT). All subjects underwent echocardiography before implant and at follow-up after 6+ months. Left ventricular mechanics was investigated at follow-up during active CRT and was repeated after a temporary interruption <5 min later. Strain analysis, performed by speckle tracking, was used to assess the entity of contraction (global longitudinal strain) and its synchronicity (standard deviation of time to peak of radial strain). Intraventricular fluid dynamics, by echographic particle image velocimetry, was used to evaluate the directional distribution of global momentum associated with blood motion. The discontinuation of CRT pacing reflects into a reduction of deformation synchrony and into the deviation of blood flow momentum from the base-apex orientation with the development of transversal flow-mediated haemodynamic forces. The deviation of flow momentum presents a significant correlation with the degree of volumetric reduction after CRT. CONCLUSION Changes in electrical activation alter the orientation of blood flow momentum. The long-term CRT outcome correlates with the degree of re-alignment of haemodynamic forces. These preliminary results suggest that flow orientation could be used for optimizing the biventricular pacing setting. However, larger prospective studies are needed to confirm this hypothesis.
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Affiliation(s)
- Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, P.le Europa 1., Trieste 34127, Italy
| | | | - Valter Bianchi
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Antonio D'Onofrio
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Pio Caso
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Giovanni Tonti
- Cardiology Division, 'G. d'Annunzio' University, Chieti, Italy
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Menet A, Guyomar Y, Ennezat PV, Graux P, Castel AL, Delelis F, Heuls S, Cuvelier E, Gevaert C, Le Goffic C, Tribouilloy C, Maréchaux S. Prognostic value of left ventricular reverse remodeling and performance improvement after cardiac resynchronization therapy: A prospective study. Int J Cardiol 2016; 204:6-11. [DOI: 10.1016/j.ijcard.2015.11.091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 01/26/2023]
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Affiliation(s)
- Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Palmisano P, Accogli M, Pisanò ECL, Zaccaria M, De Blasi S, Ponzetta MA, Valsecchi S, Milanese G, Lauretti M, Magliari F. Reduced long-term overall mortality in heart failure patients with prolonged QRS treated with CRT combined with ICD vs. heart failure patients with narrow QRS treated with ICD only. Europace 2015; 18:1374-82. [DOI: 10.1093/europace/euv347] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/16/2015] [Indexed: 11/12/2022] Open
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Pokharel P, Fujikura K, Bella JN. Clinical applications and prognostic implications of strain and strain rate imaging. Expert Rev Cardiovasc Ther 2015; 13:853-66. [DOI: 10.1586/14779072.2015.1056163] [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: 01/09/2023]
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Lessons learned from the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Trends Cardiovasc Med 2015; 26:137-46. [PMID: 26051208 DOI: 10.1016/j.tcm.2015.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 04/07/2015] [Accepted: 04/24/2015] [Indexed: 11/20/2022]
Abstract
Cardiac resynchronization therapy (CRT) has evolved as a Class I treatment indication with Level of Evidence A, in patients with mild heart failure, depressed left ventricular ejection fraction, and wide QRS. In this review article, we will discuss the major findings of sub-studies published from the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT).
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Chen Y, Cheng L, Yao H, Chen H, Wang Y, Zhao W, Pan C, Shu X. The myocardial ischemia evaluated by real-time contrast echocardiography may predict the response to cardiac resynchronization therapy: a large animal study. PLoS One 2014; 9:e113992. [PMID: 25469632 PMCID: PMC4254922 DOI: 10.1371/journal.pone.0113992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022] Open
Abstract
Evidence-based criteria for applying cardiac resynchronization therapy (CRT) in patients with ischemic cardiomyopathy are still scarce. The aim of the present study was to evaluate the predictive value of real-time myocardial contrast echocardiography (RT-MCE) in a preclinical canine model of ischemic cardiomyopathy who received CRT. Ischemic cardiomyopathy was produced by ligating the first diagonal branch in 20 beagles. Dogs were subsequently divided into two groups that were either treated with bi-ventricular pacing (CRT group) or left untreated (control group). RT-MCE was performed at baseline, before CRT, and 4 weeks after CRT. Two-dimensional speckle tracking imaging was used to evaluate the standard deviation of circumferential (Cir12SD), radial (R12SD), and longitudinal (L12SD) strains of left ventricular segments at basal as well as middle levels. Four weeks later, the Cir12SD, R12SD, and myocardial blood flow (MBF) of the treated group were significantly improved compared to their non-CRT counterparts. Furthermore, MBF values measured before CRT were significantly higher in responders than in non-responders to bi-ventricular pacing. Meanwhile, no significant differences were observed between the responder and non-responder groups in terms of Cir12SD, R12SD, and L12SD. A high degree of correlation was found between MBF values before CRT and LVEF after CRT. When MBF value>24.9 dB/s was defined as a cut-off point before CRT, the sensitivity and specificity of RT-MCE in predicting the response to CRT were 83.3% and 100%, respectively. Besides, MBF values increased significantly in the CRT group compared with the control group after 4 weeks of pacing (49.8±15.5 dB/s vs. 28.5±4.6 dB/s, p<0.05). Therefore, we considered that myocardial perfusion may be superior to standard metrics of LV synchrony in selecting appropriate candidates for CRT. In addition, CRT can improve myocardial perfusion in addition to cardiac synchrony, especially in the setting of ischemic cardiomyopathy.
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Affiliation(s)
- Yongle Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Leilei Cheng
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Haohua Yao
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Weipeng Zhao
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Shanghai, PR China
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Diab O, Lotfy HAA, Khalid S. Reverse electric remodeling after cardiac resynchronization therapy and relation to clinical and echocardiographic outcomes. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.12.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Seifert M, Schau T, Schoepp M, Arya A, Neuss M, Butter C. MitraClip in CRT non-responders with severe mitral regurgitation. Int J Cardiol 2014; 177:79-85. [DOI: 10.1016/j.ijcard.2014.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/16/2014] [Indexed: 12/30/2022]
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Sebag FA, Lellouche N, Chen Z, Tritar A, O'Neill MD, Gill J, Wright M, Leclercq C, Rinaldi CA. Positive response to cardiac resynchronization therapy reduces arrhythmic events after elective generator change in patients with primary prevention CRT-D. J Cardiovasc Electrophysiol 2014; 25:1368-75. [PMID: 25066404 DOI: 10.1111/jce.12496] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 06/27/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillators (ICD) are effective therapies for heart failure (HF) patients with cardiac dyssynchrony. Patients receiving primary prevention CRT-defibrillator that positively remodel might no longer qualify for ICD indication due to CRT-induced left ventricular ejection fraction (LVEF) improvement. We aimed to evaluate the outcome of CRT-D patients at the time of device replacement (DR). METHODS AND RESULTS Patients undergoing primary prevention CRT-D DR were prospectively included from November 2007 to March 2011 in 2 centers. CRT response was as defined as ≥1 NYHA class improvement and an increase in LVEF ≥10%. Before DR, all patients underwent echocardiography and device interrogation. Patients without theoretical ongoing ICD indication (TOII) at DR were defined as those with LVEF ≥40% without appropriate ICD therapy (appropriate therapy) during the first ICD service-life. A total of 107 consecutive patients were enrolled. Sixty-one patients (57%) were considered CRT responders after the index procedure. At the time of DR (56.4 ± 14.4 months from initial implant), 87% of CRT responders were free of appropriate therapy, compared with 70% of CRT nonresponders (P = 0.02). Thirty-nine patients (37%) did not meet the criteria for TOII. During follow-up (mean 26.4 ± 14.4 months after DR), 37 patients (95%) without TOII were free of appropriate therapy versus 49 of 68 patients (72%) with ongoing TOII (P = 0.007). By multivariable analysis, the only independent predictor of appropriate therapy after DR was TOII (hazard ratio = 6.43; P = 0.01). CONCLUSION Absence of theoretical ICD indication occurs in more than one-third of CRT-D patients undergoing DR. In addition, appropriate therapy rate is relatively low (2.2% per year) in this subgroup of patients.
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Affiliation(s)
- Frederic A Sebag
- Fédération de cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris et INSERMU955, Créteil, France; Division of Cardiovascular Medicine, St. Thomas' Hospital, Guy's and Saint Thomas NHS Trust, London, UK
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Niebauer MJ, Rickard J, Polakof L, Tchou PJ, Varma N. QRS frequency characteristics help predict response to cardiac resynchronization in left bundle branch block less than 150 milliseconds. Heart Rhythm 2014; 11:2183-9. [PMID: 25068573 DOI: 10.1016/j.hrthm.2014.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Baseline QRS duration (QRSd) ≥150 ms is a recognized predictor of clinical improvement by cardiac resynchronization therapy (CRT), particularly for those with left bundle branch (LBBB). Patients with QRSd <150 ms are considered less likely to respond. OBJECTIVE The purpose of this study was to test our theory that left ventricular dyssynchrony, although usually associated with wider QRSd, also exhibits lower QRS frequency characteristics and that low-frequency content predicts CRT response in LBBB patients. METHODS We retrospectively examined the QRS frequency content of 170 heart failure patients with LBBB and QRSd ≥120 ms using Fourier transformation. Ninety-four responders to CRT (defined as reduction in left ventricular end-systolic volume by ≥15% from baseline) were compared to 76 nonresponders (<15% reduction). Analysis of 3 standard ECG leads (I, aVF, and V3) representing the 3 dimensions of depolarization was performed, and V3 provided the best predictive value. RESULTS The QRSd of responders (160.3 ± 17.8 ms) and nonresponders (161.8 ± 21.1 ms, P = .604) were similar. We found that the percentage of total QRS frequency power below 10 Hz that exceeded 52% was most predictive of CRT response compared to other cutoff values. However, the percentage of patients with total QRS power >52% below 10 Hz was especially predictive of response in those with QRSd <150 ms. In these patients, this power threshold was highly predictive of CRT response (positive predictive value 85.7%, negative predictive value 71.4%). CONCLUSION In this group of CRT recipients with LBBB, retrospective analysis of QRS frequency content below 10 Hz had greater predictive value for CRT response than baseline QRSd, particularly in those with QRSd <150 ms.
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Carlomagno G, Iengo R, Sordelli C, Martiniello AR, Ascione R, Severino S, Caso P, Ascione L. Recoordination of opposing walls drives the response to cardiac resynchronization therapy: a longitudinal study using a strain discoordination index. J Cardiovasc Med (Hagerstown) 2014; 16:736-42. [PMID: 25022925 DOI: 10.2459/01.jcm.0000435620.70933.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIMS Intraventricular dyssynchrony has traditionally been studied by means of contraction delays between different myocardial segments. Recently, the discoordination of opposing wall contraction throughout the cardiac cycle has been proposed as a more faithful predictor of response. Aim of the current study was to evaluate which parameters - mechanical dyssynchrony or discoordination - normalize with left ventricular response to cardiac resynchronization therapy (CRT). METHODS Cardiac mechanics were analysed before and after 6 months of CRT in 53 patients with left bundle branch block and advanced heart failure. Discoordination was quantified by means of the transverse strain discoordination index (TSDI) at basal and mid-ventricular segments; this index takes into account the percentage of time in the cardiac cycle in which cardiac deformation (transverse strain) of the two opposing walls occurs in noncoordinated directions. Dyssynchrony indices included septal to lateral peak-to-peak transverse strain delay and the standard deviation of time to peak tissue velocity in 12 mid-basal segments (Yu index). RESULTS Around 63% of patients met the response criteria. Several baseline indices were predictive of reverse remodelling; TSDI at the mid-ventricular level demonstrated the best accuracy. Time from Q to peak velocity and strain tended to increase in all explored myocardial segments; despite a trend towards a decrease in septal-to-lateral strain delay, the latter decreased equally in responders and in nonresponding patients. Yu index decreased in responders more than in nonresponders, with borderline significance. Basal and medium TSDI remained unchanged in nonresponders and consistently normalized in patients who responded to CRT. The changes in TSDI were significantly correlated with improvements in left ventricular end-systolic volume and ejection fraction; the strongest correlation was observed for changes in TSDI measured at the mid-ventricular level. CONCLUSION Left ventricular reverse remodelling after CRT is accompanied by the recoordination of opposite-wall contraction, as testified by changes in mid-ventricular TSDI, which also reveals as a very good predictor of response. On the contrary, changes of segmental peak-to-peak delays (dyssynchrony indices) fail to capture the complex nature of left ventricular response to CRT.
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Affiliation(s)
- Guido Carlomagno
- aDepartment of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli bDepartment of Translational Medical Sciences, Federico II University cUnit of Cardiology, Loreto Mare Hospital dSecond University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
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Brenyo A, Barsheshet A, Kutyifa V, Ruwald AC, Rao M, Zareba W, Pouleur AC, Knappe D, Solomon SD, McNitt S, Huang DT, Moss AJ, Goldenberg I. Predictors of Spontaneous Reverse Remodeling in Mild Heart Failure Patients With Left Ventricular Dysfunction. Circ Heart Fail 2014; 7:565-72. [DOI: 10.1161/circheartfailure.113.000929] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew Brenyo
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Alon Barsheshet
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Valentina Kutyifa
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Anne-Christine Ruwald
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Mohan Rao
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Wojciech Zareba
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Anne-Catherine Pouleur
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Dorit Knappe
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Scott D. Solomon
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Scott McNitt
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - David T. Huang
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Arthur J. Moss
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
| | - Ilan Goldenberg
- From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine
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