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Mugnai G, Donazzan L, Tomasi L, Piccoli A, Cavedon S, Manfrin M, Bolzan B, Perrone C, Lavio S, Rauhe WG, Oberhollenzer R, Bilato C, Ribichini FL. Electrocardiographic predictors of echocardiographic response in cardiac resynchronization therapy: Update of an old story. J Electrocardiol 2022; 75:36-43. [PMID: 36274327 DOI: 10.1016/j.jelectrocard.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/18/2022] [Accepted: 10/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND A better selection of patients with left bundle branch block (LBBB) might increase the response to cardiac resynchronization therapy (CRT). The aim of the study was to investigate the association between the Strauss criteria, absence of S wave in V5-V6, the Selvester score and response to CRT. METHODS AND RESULTS The retrospective analysis included all consecutive patients having undergone implantation of biventricular defibrillators in primary prevention between 2018 and 2020. The final analysis included 236 patients (mean age 69.7 ± 9.9; 77.5% of males). The Strauss criteria were significantly associated with CRT response (p < 0.01) with a sensitivity of 71.3% and specificity of 64.1%. The Strauss criteria along with the absence of S wave in V5 and V6 showed a sensitivity of 56.7%, a specificity of 82.6% and a positive predictive value of 90.5%. The Selvester score was significantly and inversely associated with CRT response (OR 0.818, 95% CI 0.75-0.89; p < 0.001). The multivariable model showed that left ventricular ejection fraction (LVEF) and QRS duration (≥140 ms in males and ≥ 130 ms in females) were independently associated with CRT response (respectively OR 0.92, CI 95% 0.86-0.98, p = 0.01 and OR 3.70, CI 95% 1.12-12.21, p = 0.03). CONCLUSIONS Strauss criteria, especially in association with absence of S wave in V5 and V6, were able to increase specificity and positive predictive value for predicting CRT response. The Selvester score was inversely associated with CRT response. Finally, LVEF and QRS duration were independently associated with echocardiographic response to CRT.
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Affiliation(s)
- Giacomo Mugnai
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
| | - Luca Donazzan
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Luca Tomasi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Anna Piccoli
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Stefano Cavedon
- Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
| | - Massimiliano Manfrin
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Bruna Bolzan
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Cosimo Perrone
- Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
| | | | - Werner Günther Rauhe
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Rainer Oberhollenzer
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Claudio Bilato
- Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
| | - Flavio Luciano Ribichini
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
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The role of cardiac magnetic resonance in identifying appropriate candidates for cardiac resynchronization therapy - a systematic review of the literature. Heart Fail Rev 2022; 27:2095-2118. [PMID: 36045189 DOI: 10.1007/s10741-022-10263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Abstract
Despite the strict indications for cardiac resynchronization therapy (CRT) implantation, a significant proportion of patients will fail to adequately respond to the treatment. This systematic review aims to present the existing evidence about the role of cardiac magnetic resonance (CMR) in identifying patients who are likely to respond better to the CRT. A systematic search in the MedLine database and Cochrane Library from their inception to August 2021 was performed, without any limitations, by two independent investigators. We considered eligible observational studies or randomized clinical trials (RCTs) that enrolled patients > 18 years old with heart failure (HF) of ischaemic or non-ischaemic aetiology and provided data about the association of baseline CMR variables with clinical or echocardiographic response to CRT for at least 3 months. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). Following our search strategy, 47 studies were finally included in our review. CMR appears to have an additive role in identifying the subgroup of patients who will respond better to CRT. Specifically, the presence and the extent of myocardial scar were associated with increased non-response rates, while those with no scar respond better. Furthermore, existing data show that scar location can be associated with CRT response rates. CMR-derived markers of mechanical desynchrony can also be used as predictors of CRT response. CMR data can be used to optimize the position of the left ventricular lead during the CRT implantation procedure. Specifically, positioning the left ventricular lead in a branch of the coronary sinus that feeds an area with transmural scar was associated with poorer response to CRT. CMR can be used as a non-invasive optimization tool to identify patients who are more likely to achieve better clinical and echocardiographic response following CRT implantation.
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Vacarescu C, Luca CT, Feier H, Gaiță D, Crișan S, Negru AG, Iurciuc S, Goanță EV, Mornos C, Lazăr MA, Streian CG, Arnăutu DA, Turi VR, Cozma D. Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing. Diagnostics (Basel) 2022; 12:1096. [PMID: 35626251 PMCID: PMC9139204 DOI: 10.3390/diagnostics12051096] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Betablockers (BB)/ivabradine titration in fusion CRT pacing (CRTP) is understudied. Aim: To assess drug optimization using systematic exercise tests (ET) in fusion CRTP with preserved atrioventricular conduction (AVc). Methods: Changes in drug management were assessed during systematic follow-ups in CRTP patients without right ventricle lead. Shorter AVc (PR interval) allowed BB up-titration, while longer AVc needed BB down-titration, favoring ivabradine. Constant fusion pacing was the goal to improve outcomes. Results: 64 patients, 62.5 ± 9.5 y.o divided into three groups: shorter PR (<160 ms), normal (160−200 ms), longer (200−240 ms); follow-up 59 ± 26 months. Drugs were titrated in case of: capture loss due to AVc shortening (14%), AVc lengthening (5%), chronotropic incompetence (11%), maximum tracking rate issues (9%), brady/tachyarrhythmias (8%). Interventions: BB up-titration (78% shorter PR, 19% normal PR, 5% longer PR), BB down-titration (22% shorter PR, 14% normal PR), BB exclusion (16% longer PR), adding/up-titration ivabradine (22% shorter PR, 19% normal PR, 5% longer PR), ivabradine down-titration (22% shorter PR, 3% normal PR), ivabradine exclusion (11% normal PR, 5% longer PR). Drug strategy was changed in 165 follow-ups from 371 recorded (42% patients). Conclusions: BBs/ivabradine titration and routine ET during follow-ups in patients with fusion CRTP should be a standard approach to maximize resynchronization response. Fusion CRTP showed a positive outcome with important LV reverse remodeling and significant LVEF improvement in carefully selected patients.
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Affiliation(s)
- Cristina Vacarescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Horea Feier
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dan Gaiță
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Simina Crișan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Alina-Gabriela Negru
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Stela Iurciuc
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
| | - Emilia-Violeta Goanță
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristian Mornos
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Mihai-Andrei Lazăr
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Caius-Glad Streian
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Diana-Aurora Arnăutu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
| | - Vladiana-Romina Turi
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dragos Cozma
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (C.V.); (H.F.); (D.G.); (A.-G.N.); (S.I.); (E.-V.G.); (C.M.); (M.-A.L.); (C.-G.S.); (D.-A.A.); (V.-R.T.); (D.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Lapidot D, Rav-Acha M, Bdolah-Abram T, Farkash R, Glikson M, Hasin T. QRS Narrowing Following CRT Implantation: Predictors, Dynamics, and Association with Improved Long-Term Outcome. J Clin Med 2022; 11:jcm11051279. [PMID: 35268370 PMCID: PMC8911497 DOI: 10.3390/jcm11051279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Heart failure (HF) patients with wide QRS often benefit from cardiac resynchronization therapy (CRT), although QRS narrowing does not always occur. The current study investigates the incidence and predictors for QRS narrowing following CRT and its long-term impact on clinical outcomes. Methods: Among individuals undergoing clinically indicated CRT, pre-and post-implantation electrocardiographs were meticulously analyzed for QRS duration change. All-cause mortality and the composite of mortality and HF hospitalizations were retrieved. Results: For 104 patients, mean age 67 years, 25% females, QRS narrowed within days by 20.2 ± 24.7 ms. In 55/104 (53%) QRS narrowed by ≥20 ms (“acute narrowing”). Female gender and baseline QRS predicted acute narrowing. Acute narrowing persisted for 1−6 weeks in 18/20 (90%) and 3−12 months in 21/31 (68%) of patients. During the average follow-up of 41 months, 29/104 (28%) died and 50/104 (48%) met the composite outcome. In a multivariable analysis including comorbidities and cardiac history, prolonged baseline PR interval (HR 1.015, CI 1.008−1.021, p < 0.001) and acute narrowing < 20 ms (HR 3.243, CI 1.593−6.603, p = 0.001) were significant and independent predictors for the composite outcome. Conclusions: Post-CRT acute QRS narrowing ≥ 20 ms is independently associated with favorable long-term outcomes and might be considered as a novel measure for procedural success.
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Affiliation(s)
- Daniel Lapidot
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
| | - Moshe Rav-Acha
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center (SZMC), Jerusalem 9103102, Israel;
| | - Tali Bdolah-Abram
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
| | - Rivka Farkash
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center (SZMC), Jerusalem 9103102, Israel;
| | - Michael Glikson
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center (SZMC), Jerusalem 9103102, Israel;
| | - Tal Hasin
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel; (D.L.); (M.R.-A.); (T.B.-A.); (M.G.)
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center (SZMC), Jerusalem 9103102, Israel;
- Correspondence: ; Tel.: +972-2-6555955; Fax: +972-2-6555437
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5
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Rodero C, Strocchi M, Lee AWC, Rinaldi CA, Vigmond EJ, Plank G, Lamata P, Niederer SA. Impact of anatomical reverse remodelling in the design of optimal quadripolar pacing leads: A computational study. Comput Biol Med 2022; 140:105073. [PMID: 34852973 PMCID: PMC8752960 DOI: 10.1016/j.compbiomed.2021.105073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
Lead position is an important factor in determining response to Cardiac Resynchronization Therapy (CRT) in dyssynchronous heart failure (HF) patients. Multipoint pacing (MPP) enables pacing from multiple electrodes within the same lead, improving the potential outcome for patients. Virtual quadripolar lead designs were evaluated by simulating pacing from all combinations of 1 and 2 electrodes along the lead in each virtual patient from cohorts of HF (n = 24) and simulated reverse remodelled (RR, n = 20) patients. Electrical synchrony was assessed by the time 90% of the ventricular myocardium is activated (AT090). Optimal 1 and 2 electrode pacing configurations for AT090 were combined to identify the 4-electrode lead design that maximised benefits across all patients. LV pacing in the HF cohort in all possible single and double electrode locations reduced AT090 by 14.48 ± 5.01 ms (11.92 ± 3.51%). The major determinant of reduction in activation time was patient anatomy. Pacing with a single optimal lead design reduced AT090 more in the HF cohort than the RR cohort (12.68 ± 3.29% vs 10.81 ± 2.34%). Pacing with a single combined HF and RR population-optimised lead design achieves electrical resynchronization with near equivalence to personalised lead designs both in HF and RR anatomies. These findings suggest that although lead configurations have to be tailored to each patient, a single optimal lead design is sufficient to obtain near-optimal results across most patients. This study shows the potential of virtual clinical trials as tools to compare existing and explore new lead designs.
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Affiliation(s)
- Cristobal Rodero
- Cardiac Electro-Mechanics Research Group, Biomedical Engineering Department, King ́s College London, London, United Kingdom.
| | - Marina Strocchi
- Cardiac Electro-Mechanics Research Group, Biomedical Engineering Department, King ́s College London, London, United Kingdom
| | - Angela W C Lee
- Cardiac Electro-Mechanics Research Group, Biomedical Engineering Department, King ́s College London, London, United Kingdom
| | - Christopher A Rinaldi
- King's College London, Interdisciplinary Medical Imaging Group, London, United Kingdom
| | - Edward J Vigmond
- Institute of Electrophysiology and Heart Modeling, Foundation Bordeaux University, Bordeaux, France; Bordeaux Institute of Mathematics, UMR-5251, University of Bordeaux, Bordeaux, France
| | - Gernot Plank
- Medical University of Graz, Gottfried Schatz Research Center - Biophysics, Graz, Austria
| | - Pablo Lamata
- Cardiac Electro-Mechanics Research Group, Biomedical Engineering Department, King ́s College London, London, United Kingdom
| | - Steven A Niederer
- Cardiac Electro-Mechanics Research Group, Biomedical Engineering Department, King ́s College London, London, United Kingdom
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Waddingham PH, Lambiase P, Muthumala A, Rowland E, Chow AW. Fusion Pacing with Biventricular, Left Ventricular-only and Multipoint Pacing in Cardiac Resynchronisation Therapy: Latest Evidence and Strategies for Use. Arrhythm Electrophysiol Rev 2021; 10:91-100. [PMID: 34401181 PMCID: PMC8335856 DOI: 10.15420/aer.2020.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
Despite advances in the field of cardiac resynchronisation therapy (CRT), response rates and durability of therapy remain relatively static. Optimising device timing intervals may be the most common modifiable factor influencing CRT efficacy after implantation. This review addresses the concept of fusion pacing as a method for improving patient outcomes with CRT. Fusion pacing describes the delivery of CRT pacing with a programming strategy to preserve intrinsic atrioventricular (AV) conduction and ventricular activation via the right bundle branch. Several methods have been assessed to achieve fusion pacing. QRS complex duration (QRSd) shortening with CRT is associated with improved clinical response. Dynamic algorithm-based optimisation targeting narrowest QRSd in patients with intact AV conduction has shown promise in people with heart failure with left bundle branch block. Individualised dynamic programming achieving fusion may achieve the greatest magnitude of electrical synchrony, measured by QRSd narrowing.
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Affiliation(s)
- Peter H Waddingham
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pier Lambiase
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,UCL Institute of Cardiovascular Science University College London, London, UK
| | - Amal Muthumala
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Edward Rowland
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Wc Chow
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
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7
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Bazoukis G, Naka KK, Alsheikh-Ali A, Tse G, Letsas KP, Korantzopoulos P, Liu T, Yeung C, Efremidis M, Tsioufis K, Baranchuk A, Stavrakis S. Association of QRS narrowing with response to cardiac resynchronization therapy-a systematic review and meta-analysis of observational studies. Heart Fail Rev 2021; 25:745-756. [PMID: 31392534 DOI: 10.1007/s10741-019-09839-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Prolonged QRS duration, which reflects a higher degree of mechanical dysynchrony, is a predictor of response to CRT. However, the association of QRS narrowing after biventricular pacing with CRT response rates is not clear. Our aim was to conduct a systematic review and meta-analysis on the association between QRS narrowing after cardiac resynchronization therapy (CRT) and clinical and echocardiographic response to CRT in patients with heart failure. Two independent investigators searched MedLine and EMBASE databases through July 2018 without any limitations. Studies providing estimates (continuous data) on the association of QRS shortening with either clinical (defined as New York Heart Association (NYHA) reduction ≥ 1) or echocardiographic (defined as left ventricular end-systolic volume (LVESV) reduction ≥ 15%) response to CRT were finally included in the quantitative synthesis. We included 32 studies (14 studies (1274 patients mean age 64 years old, males 79.3%) using clinical CRT response and 18 studies (1270 patients, mean age 64 years old, males 69.1%) using echocardiographic CRT response). A significant association between QRS narrowing and shorter attained QRS duration with clinical and echocardiographic CRT response was observed. The observed association was independent of the timing of QRS width measurement after CRT implantation. Acute and late improvement of electrical dysynchrony as depicted by QRS narrowing following biventricular pacing is associated with clinical and echocardiographic response to CRT. However, large prospective studies are needed to further examine our findings.
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Affiliation(s)
- George Bazoukis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece. .,The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Katerina K Naka
- Second Department of Cardiology, University of Ioannina, GR 45110, Ioannina, Greece
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | | | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Cynthia Yeung
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Michael Efremidis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Stavros Stavrakis
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Jackson T, Claridge S, Behar J, Yao C, Elliott M, Mehta V, Gould J, Sidhu B, Pereira H, Niederer S, Carr-White G, Rinaldi CA. Noninvasive electrocardiographic assessment of ventricular activation and remodeling response to cardiac resynchronization therapy. Heart Rhythm O2 2021; 2:12-18. [PMID: 34113900 PMCID: PMC8183873 DOI: 10.1016/j.hroo.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Cardiac resynchronization therapy (CRT) produces acute changes in electric resynchronization that can be measured noninvasively with electrocardiographic body surface mapping (ECGi). The relation between baseline acute electrophysiology metrics and their manipulation with CRT and reverse remodeling is unclear. Objective To test (ECGi) derived parameters of electrical activation as predictors of volumetric response to CRT. Methods ECGi was performed in 21 patients directly following CRT implant. Activation parameters (left ventricular total activation time [LVtat], global biventricular total activation time [VVtat], global left/right ventricular electrical synchrony [VVsync], and global left ventricular dispersion of activation times [LVdisp]) were measured at baseline and following echocardiographically optimized CRT. Remodeling response (>15% reduction left ventricular end-systolic volume) was assessed 6 months post CRT. Results Patients were aged 68.9 ± 12.1 years, 81% were male, and 57% were ischemic. Baseline measures of dyssynchrony were more pronounced in left bundle branch block (LBBB) vs non-LBBB. ECGi demonstrated a trend of greater interventricular dyssynchrony between responders and nonresponders that did not reach statistical significance (VVsync: -45.7 ± 22.4 ms vs -25.1 ± 29.3 ms, P = .227). Remaining activation parameters were similar between responders and nonresponders (VVtat 101 ± 22.0 ms vs 98.9 ± 23.4 ms, P = .838; LVtat 86.4 ± 17.1 ms vs 85.1 ± 27.7 ms, P = .904; LVdisp 28.2 ± 6.3 ms vs 27.0 ± 8.7 ms, P = .726). In volumetric responders activation parameters were significantly improved with CRT compared to nonresponders: VV sync (-45.67 ± 22.41 ms vs 2.33±18.87 ms, P = .001), VVtat (101 ± 22.04 ms vs 71 ± 14.01 ms, P = .002), LVtat (86.44 ± 17.15 ms vs 67.67 ± 11.31 ms, P = .006), and LVdisp (28.22 ± 6.3 ms vs 21.56 ± 4.45 ms, P = .008). Conclusion Baseline ECGi activation times did not predict CRT volumetric response. Volumetric responders exhibited significant improvements in ECGi-derived metrics with CRT. ECGi does not select CRT candidates but may be a useful adjunct to guide left ventricle lead implants and to perform postimplant CRT optimization.
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Affiliation(s)
- Thomas Jackson
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Simon Claridge
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Behar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Cheng Yao
- Medtronic Ltd./CardioInsight, Cleveland, Ohio
| | - Mark Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Baldeep Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Helder Pereira
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Guy's and St Thomas' NHS Trust, London, United Kingdom
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9
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Melki L, Wang DY, Grubb CS, Weber R, Biviano A, Wan EY, Garan H, Konofagou EE. Cardiac Resynchronization Therapy Response Assessment with Electromechanical Activation Mapping within 24 Hours of Device Implantation: A Pilot Study. J Am Soc Echocardiogr 2021; 34:757-766.e8. [PMID: 33675941 DOI: 10.1016/j.echo.2021.02.012] [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: 07/30/2020] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) response assessment relies on the QRS complex narrowing criterion. Yet one third of patients do not improve despite narrowed QRS after implantation. Electromechanical wave imaging (EWI) is a quantitative echocardiography-based technique capable of noninvasively mapping cardiac electromechanical activation in three dimensions. The aim of this exploratory study was to investigate the EWI technique, sensitive to ventricular dyssynchrony, for informing CRT response on the day of implantation. METHODS Forty-four patients with heart failure with left bundle branch block or right ventricular (RV) paced rhythm and decreased left ventricular ejection fraction (LVEF; mean, 25.3 ± 9.6%) underwent EWI without and with CRT within 24 hours of device implantation. Of those, 16 were also scanned while in left ventricular (LV) pacing. Improvement in LVEF at 3-, 6-, or 9-month follow-up defined (1) super-responders (ΔLVEF ≥ 20%), (2) responders (10% ≤ ΔLVEF < 20%), and (3) nonresponders (ΔLVEF ≤ 5%). Three-dimensionally rendered electromechanical maps were obtained under RV, LV, and biventricular CRT pacing conditions. Mean RV free wall and LV lateral wall activation times were computed. The percentage of resynchronized myocardium was measured by quantifying the percentage of the left ventricle activated within 120 msec of QRS onset. Correlations between percentage of resynchronized myocardium and type of CRT response were assessed. RESULTS LV lateral wall activation time was significantly different (P ≤ .05) among all three pacing conditions in the 16 patients: LV lateral wall activation time with CRT in biventricular pacing (73.1 ± 17.6 msec) was lower compared with LV pacing (89.5 ± 21.5 msec) and RV pacing (120.3 ± 17.8 msec). Retrospective analysis showed that the percentage of resynchronized myocardium with CRT was a reliable response predictor within 24 hours of implantation for significantly (P ≤ .05) identifying super-responders (n = 7; 97.7 ± 1.9%) from nonresponders (n = 17; 89.9 ± 9.9%). CONCLUSION Electromechanical activation mapping constitutes a valuable three-dimensional visualization tool within 24 hours of implantation and could potentially aid in the timely assessment of CRT response rates, including during implantation for adjustment of lead placement and pacing outcomes.
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Affiliation(s)
- Lea Melki
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Daniel Y Wang
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Christopher S Grubb
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Rachel Weber
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elisa E Konofagou
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York; Department of Radiology, Columbia University Irving Medical Center, New York, New York.
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10
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Khalifa MMM, Said A, Mortada A, Shehata H. QRS Duration as a Predictor of Left Ventricular Outflow Tract Velocity Time Integral in Patient with Cardiac Resynchronization Therapy. J Cardiovasc Echogr 2020; 30:68-74. [PMID: 33282643 PMCID: PMC7706376 DOI: 10.4103/jcecho.jcecho_66_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/07/2019] [Accepted: 03/31/2020] [Indexed: 11/04/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) has a morbidity and mortality benefits in moderate to severe heart failure. It reduces mortality and hospitalization and improves cardiac function. It can be used according to the European guidelines in severely depressed left ventricular ejection fraction (i.e., ≤35%) and complete left bundle branch block. However, 30% of patients may show no benefit from CRT therapy. Therefore, prediction of CRT response seems to be an important subject for study in the current researches. We aimed to study the correlation between Surface ECG QRS complex duration (QRS) duration and cardiac output measured by ventricular outflow tract velocity time integral (LVOT VTI) as a predictor of response in patients with CRT implantation. Methods We studied 100 consecutive patients prospectively with biventricular pacing system. The patients were studied at the pacemaker follow-up clinic. Each patient was subjected to: Full medical history, general and local examination, a 12 lead electrocardiogram and QRS duration in ms was measured. All patients were subjected to a focused transthoracic echocardiographic examination in which a parasternal long axis view was obtained to measure the diameter of the LVOT diameter in mid-systole. The LVOT VTI was measured by pulsed-wave Doppler in the LVOT using a 2-mm sample volume positioned just proximal to the aortic valve in the apical five chamber view. Results We found a statistically significant difference between CRT responders and nonresponders as regards age, body surface area (BSA), time since CRT implantation and smoking status (P = 0.018, 0.039, 0.002, <0.001). There was negative significant correlation between QRS duration and LVOT VTI and stroke volume index. The optimal cut off values for optimal response to CRT using receiver operating characteristics curves were 130 ms for postimplant QRS duration and 17.1 cm for LVOT VTI. We also found a significant difference between responders and nonresponders as regard CO. It was higher in responders (5.97 vs. 3.34, P < 0.001). Conclusion CRT response is more in patients with lower BSA, and without previous history of ischemic heart disease or smoking. There is a significant negative correlation between QRS duration and LVOT VTI.
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Affiliation(s)
| | - Ahmed Said
- Department of Cardiology, Ain Shams University Hospital, Cairo, Egypt
| | - Ayman Mortada
- Department of Cardiology, Ain Shams University Hospital, Cairo, Egypt
| | - Hassan Shehata
- Department of Cardiology, Ain Shams University Hospital, Cairo, Egypt
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11
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Riedlbauchová L, Adla T, Suchánek V, Ložek M, Tomis J, Hozman J, Tomek V, Veselka J, Janoušek J. Is left bundle branch block pattern on the ECG caused by variable ventricular activation sequence? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:486-494. [DOI: 10.1111/pace.13914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/13/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Lucie Riedlbauchová
- Department of CardiologyMotol University Hospital and 2nd Faculty of Medicine, Charles University Prague Czech Republic
| | - Theodor Adla
- Department of RadiologyMotol University Hospital and 2nd Faculty of Medicine, Charles University Prague Czech Republic
| | - Vojtěch Suchánek
- Department of CardiologyMotol University Hospital and 2nd Faculty of Medicine, Charles University Prague Czech Republic
| | - Miroslav Ložek
- Children's Heart CentreMotol University Hospital, 1st and 2nd Faculty of Medicine, Charles University Prague Czech Republic
| | - Jan Tomis
- Department of CardiologyMotol University Hospital and 2nd Faculty of Medicine, Charles University Prague Czech Republic
| | - Jiří Hozman
- Department of Biomedical Technology, Faculty of Biomedical EngineeringCzech Technical University in Prague Czech Republic
| | - Viktor Tomek
- Children's Heart CentreMotol University Hospital, 1st and 2nd Faculty of Medicine, Charles University Prague Czech Republic
| | - Josef Veselka
- Department of CardiologyMotol University Hospital and 2nd Faculty of Medicine, Charles University Prague Czech Republic
| | - Jan Janoušek
- Children's Heart CentreMotol University Hospital, 1st and 2nd Faculty of Medicine, Charles University Prague Czech Republic
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12
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Ma J, Liu Y, Dong Y, Chen M, Xia L, Xu M. Association between changes in QRS width and echocardiographic responses to cardiac resynchronization therapy: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18684. [PMID: 31914066 PMCID: PMC6959877 DOI: 10.1097/md.0000000000018684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Numerous studies have illustrated the association of QRS width with the incidence of echocardiographic response to cardiac resynchronization therapy (CRT). This study aimed to summarize the observational studies regarding the magnitude of change in QRS width between responders and nonresponders to CRT. METHODS The PubMed, Embase, and the Cochrane Library were systematically searched for relevant studies investigating the changes of QRS width with the incidence of echocardiographic response to CRT from inception till May 2019. The pooled weighted mean difference (WMD) with 95% confidence interval (CI) was calculated through random-effects model. RESULTS Five prospective and 6 retrospective studies with a total of 1524 patients were selected for final analysis. The reduction of QRS width in responders was significantly greater than nonresponders (WMD: -20.54 ms; 95% CI: -26.78 to -14.29; P < .001). Moreover, responders were associated with greater percentage reduction in QRS width when compared with nonresponders (WMD: -8.80%; 95% CI: -13.08 to -4.52; P < .001). Finally, the mean change in QRS width between responders and nonresponders differed when stratified by country, study design, mean age, percentage male, ejection fraction, measuring time of postimplanted QRS, ischemic cardiomyopathy, atrial fibrillation, and study quality. CONCLUSIONS These findings indicated that shortening QRS width after CRT device implantation showed association with greater incidence of echocardiographic responses to CRT. Further prospective studies should be conducted to evaluate the prognostic values of QRS width on the incidence of echocardiographic response to CRT.
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Affiliation(s)
- Jing Ma
- Division of Cardiology, Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University
| | - Yi Liu
- Department of Ultrasonography, Shuguang Hospital, University of Traditional Chinese Medicine
| | - Yun Dong
- Department of Ultrasonography, East Hospital, Tongji University, Shanghai, China
| | - Ming Chen
- Department of Ultrasonography, East Hospital, Tongji University, Shanghai, China
| | - Lianghua Xia
- Department of Ultrasonography, East Hospital, Tongji University, Shanghai, China
| | - Min Xu
- Department of Ultrasonography, East Hospital, Tongji University, Shanghai, China
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13
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Sieniewicz BJ, Jackson T, Claridge S, Pereira H, Gould J, Sidhu B, Porter B, Niederer S, Yao C, Rinaldi CA. Optimization of CRT programming using non-invasive electrocardiographic imaging to assess the acute electrical effects of multipoint pacing. J Arrhythm 2019; 35:267-275. [PMID: 31007792 PMCID: PMC6457383 DOI: 10.1002/joa3.12153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/13/2018] [Indexed: 12/07/2022] Open
Abstract
Aim Quadripolar lead technology and multi-point pacing (MPP) are important clinical adjuncts in cardiac resynchronization therapy (CRT) pacing aimed at reducing the rate of non-response to therapy. Mixed results have been achieved using MPP and it is critical to identify which patients require this approach and how to configure their MPP stimulation, in order to achieve optimal electrical resynchronization. Methods & Results We sought to investigate whether electrocardiographic imaging (ECGi), using the CARDIOINSIGHT ™ inverse ECG mapping system, could identify alterations in electrical resynchronization during different methods of device optimization. In no patient did a single form of programming optimization provide the best electrical response. The effects of utilizing MPP were idiosyncratic and highly patient specific. ECGi activation maps were clearly able to discern changes in bulk LV activation during differing MPP programming. In two of the five subjects, MPP resulted in more rapid activation of the left ventricle compared to standard CRT; however, in the remaining three patients, the use of MPP did not appear to acutely improve electrical resynchronization. Crucially, this cohort showed evidence of extensive LV scarring which was well visualized using both CMR and ECGi voltage mapping. Conclusions Our work suggests a potential role for ECGi in the optimization of non-responders to CRT, as it allows the fusion of activation maps and scar analysis above and beyond interrogation of the 12 lead ECG.
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Affiliation(s)
- Benjamin J Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Tom Jackson
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Helder Pereira
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Baldeep Sidhu
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK
| | - Cheng Yao
- CardioInsight Technologies, Medtronic Minneapolis Minnesota
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
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14
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Carpio EF, Gomez JF, Sebastian R, Lopez-Perez A, Castellanos E, Almendral J, Ferrero JM, Trenor B. Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study. Front Physiol 2019; 10:74. [PMID: 30804805 PMCID: PMC6378298 DOI: 10.3389/fphys.2019.00074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Patients suffering from heart failure and left bundle branch block show electrical ventricular dyssynchrony causing an abnormal blood pumping. Cardiac resynchronization therapy (CRT) is recommended for these patients. Patients with positive therapy response normally present QRS shortening and an increased left ventricle (LV) ejection fraction. However, around one third do not respond favorably. Therefore, optimal location of pacing leads, timing delays between leads and/or choosing related biomarkers is crucial to achieve the best possible degree of ventricular synchrony during CRT application. In this study, computational modeling is used to predict the optimal location and delay of pacing leads to improve CRT response. We use a 3D electrophysiological computational model of the heart and torso to get insight into the changes in the activation patterns obtained when the heart is paced from different regions and for different atrioventricular and interventricular delays. The model represents a heart with left bundle branch block and heart failure, and allows a detailed and accurate analysis of the electrical changes observed simultaneously in the myocardium and in the QRS complex computed in the precordial leads. Computational simulations were performed using a modified version of the O'Hara et al. action potential model, the most recent mathematical model developed for human ventricular electrophysiology. The optimal location for the pacing leads was determined by QRS maximal reduction. Additionally, the influence of Purkinje system on CRT response was assessed and correlation analysis between several parameters of the QRS was made. Simulation results showed that the right ventricle (RV) upper septum near the outflow tract is an alternative location to the RV apical lead. Furthermore, LV endocardial pacing provided better results as compared to epicardial stimulation. Finally, the time to reach the 90% of the QRS area was a good predictor of the instant at which 90% of the ventricular tissue was activated. Thus, the time to reach the 90% of the QRS area is suggested as an additional index to assess CRT effectiveness to improve biventricular synchrony.
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Affiliation(s)
- Edison F Carpio
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Juan F Gomez
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Rafael Sebastian
- Computational Multiscale Simulation Lab (CoMMLab), Department of Computer Science, Universitat de València, Valencia, Spain
| | - Alejandro Lopez-Perez
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Eduardo Castellanos
- Electrophysiology Laboratory and Arrhythmia Unit, Grupo HM Hospitales, Hospital Monteprincipe, University CEU-San Pablo, Madrid, Spain
| | - Jesus Almendral
- Electrophysiology Laboratory and Arrhythmia Unit, Grupo HM Hospitales, Hospital Monteprincipe, University CEU-San Pablo, Madrid, Spain
| | - Jose M Ferrero
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Beatriz Trenor
- Centre for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
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15
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Takenaka M, Inden Y, Yanagisawa S, Fujii A, Ando M, Funabiki J, Murase Y, Otake N, Sakamoto Y, Shibata R, Murohara T. Myocardial viability as shown by left ventricular lead pacing threshold and improved dyssynchrony by QRS narrowing predicts the response to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2018; 30:311-319. [PMID: 30516312 DOI: 10.1111/jce.13806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with advanced heart failure and dyssynchrony can benefit from cardiac resynchronization therapy (CRT). To predict the response to CRT, myocardial viability and improved dyssynchrony are suggested to be important. METHODS We retrospectively investigated 93 patients who underwent CRT implantation in Nagoya University Hospital. We assessed QRS narrowing the day after implantation to measure the improvement in dyssynchrony and measured the left ventricular pacing threshold (LVPT) to determine the local myocardial viability in all patients. Responders to CRT were defined as those having a greater than or equal to 15% decrease in left ventricular end-systolic volume by echocardiography at their 6-month follow-up. RESULTS Sixty-two patients (67%) were classified as responders. The QRS width before CRT implantation, QRS narrowing after implantation, left atrial diameter, septal-to-posterior wall motion delay, left ventricular end-diastolic diameter, radial strain, and LVPT were significantly different between the responder and nonresponder groups. On multivariate analysis, QRS narrowing (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05; P = 0.005) and LVPT (OR, 0.42; 95% CI, 0.22-0.82; P = 0.011) were independent predictors of a response to CRT. We calculated the cutoff values from the receiver operating characteristic curves as 22.5 milliseconds of QRS narrowing and 1.55 V of LVPT. The response rates in patients with both predictive factors (QRS narrowing ≥ 22.5 milliseconds and LVPT ≤ 1.55 V), one factor, and no factors were 91%, 61%, and 25%, respectively (P < 0.001). CONCLUSION Both myocardial viability and improved electrical dyssynchrony may be essential to predict a good response to CRT.
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Affiliation(s)
- Masaki Takenaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yanagisawa
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aya Fujii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Monami Ando
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junya Funabiki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yosuke Murase
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriaki Otake
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Behar JM, Claridge S, Niederer S, Rinaldi CA. Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy. Expert Rev Med Devices 2018; 15:555-570. [PMID: 30019954 PMCID: PMC6178093 DOI: 10.1080/17434440.2018.1502084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/12/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment. AREAS COVERED This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT. EXPERT COMMENTARY Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.
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Affiliation(s)
- Benjamin J. Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
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17
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Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
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18
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Separham A, Pourafkari L, Kazemi B, Haghizadeh Y, Akbarzadeh F, Toufan M, Sate H, Nader ND. Vitamin D deficiency and functional response to CRT in heart failure patients. Herz 2017; 44:147-154. [DOI: 10.1007/s00059-017-4630-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 01/07/2023]
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19
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De Pooter J, El Haddad M, Stroobandt R, De Buyzere M, Timmermans F. Accuracy of computer-calculated and manual QRS duration assessments: Clinical implications to select candidates for cardiac resynchronization therapy. Int J Cardiol 2017; 236:276-282. [DOI: 10.1016/j.ijcard.2017.01.129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 12/28/2022]
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20
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Reddy VY, Miller MA, Neuzil P, Søgaard P, Butter C, Seifert M, Delnoy PP, van Erven L, Schalji M, Boersma LV, Riahi S. Cardiac Resynchronization Therapy With Wireless Left Ventricular Endocardial Pacing. J Am Coll Cardiol 2017; 69:2119-2129. [DOI: 10.1016/j.jacc.2017.02.059] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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21
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Végh EM, Kandala J, Januszkiewicz L, Ren J, Miller A, Orencole M, Blendea D, Merkely B, Gellér L, Singh JP, Borgquist R. A new simplified electrocardiographic score predicts clinical outcome in patients treated with CRT. Europace 2017; 20:492-500. [DOI: 10.1093/europace/euw382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/31/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eszter M Végh
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
- Semmelweis University, Heart and Vascular Center, Városmajor 68, 1122 Budapest, Hungary
| | - Jagdesh Kandala
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Lukasz Januszkiewicz
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Jen Ren
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Alexandra Miller
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Mary Orencole
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Dan Blendea
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Béla Merkely
- Semmelweis University, Heart and Vascular Center, Városmajor 68, 1122 Budapest, Hungary
| | - László Gellér
- Semmelweis University, Heart and Vascular Center, Városmajor 68, 1122 Budapest, Hungary
| | - Jagmeet P Singh
- Cardiology Division, Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2750, USA
| | - Rasmus Borgquist
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Cardiology, Lund, Sweden
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22
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Chen JY, Lin KH, Chang KC, Chou CY. The Shortest QRS Duration of an Electrocardiogram Might Be an Optimal Electrocardiographic Predictor for Response to Cardiac Resynchronization Therapy. Int Heart J 2017; 58:530-535. [PMID: 28701672 DOI: 10.1536/ihj.16-364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jan-Yow Chen
- Division of Cardiology, Department of Medicine, China Medical University Hospital
- School of Medicine, China Medical University
| | - Kuo-Hung Lin
- Division of Cardiology, Department of Medicine, China Medical University Hospital
- School of Medicine, China Medical University
| | - Kuan-Cheng Chang
- Division of Cardiology, Department of Medicine, China Medical University Hospital
- School of Medicine, China Medical University
| | - Che-Yi Chou
- School of Medicine, China Medical University
- Division of General Medicine, Department of Medicine, China Medical University Hospital
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23
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Korantzopoulos P, Zhang Z, Li G, Fragakis N, Liu T. Meta-Analysis of the Usefulness of Change in QRS Width to Predict Response to Cardiac Resynchronization Therapy. Am J Cardiol 2016; 118:1368-1373. [PMID: 27634027 DOI: 10.1016/j.amjcard.2016.07.070] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
The existing data regarding the role of QRS duration (QRSd) change on cardiac resynchronization therapy (CRT) response show some inconsistent results. We conducted a meta-analysis of data obtained from observational studies to examine the impact of QRS change after CRT device implantation on the clinical and/or echocardiographic response. We searched the PubMed and EMBASE databases for relevant studies published before January 2016. Twenty-seven studies were retrieved for detailed evaluation of which 12 studies with a total population of 1,545 patients met our eligibility criteria. The analysis demonstrated that QRSd narrowing was a positive predictor of response to CRT (mean difference [MD] = -19.24 ms, 95% CI = -24.00 to -14.48 ms, p <0.00001). This effect was consistent in the studies using clinical criteria (MD = -19.91 ms, 95% CI = -27.20 to -12.62 ms, p <0.00001) and in those that used echocardiographic criteria (MD = -19.51 ms, 95% CI = -25.78 to -13.25 ms, p <0.00001). The heterogeneity test showed moderate differences among the individual studies (I2 = 42%). Subgroup analysis showed that QRSd change was more pronounced in studies having a follow-up ≤6 months. We did not find significant differences in studies measuring postimplantation QRSd after a certain follow-up period compared with studies measuring QRSd immediately after CRT device implantation. Further studies should clarify the exact timing of QRSd assessments during follow-up. In conclusion, QRSd shortening after CRT device implantation is associated with a favorable clinical and echocardiographic response.
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24
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Magnitude of QRS duration reduction after biventricular pacing identifies responders to cardiac resynchronization therapy. Int J Cardiol 2016; 221:450-5. [PMID: 27414720 DOI: 10.1016/j.ijcard.2016.06.203] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 05/12/2016] [Accepted: 06/25/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several studies have investigated the association between native QRS duration (QRSd) or QRS narrowing and response to biventricular pacing. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who undergo cardiac resynchronization therapy (CRT) implantation. METHODS AND RESULTS We included 311 patients in whom a CRT device was implanted in accordance with current guidelines for CRT. On implantation, the native QRS, the QRSd and the QI during CRT were measured. After 6months, 220 (71%) patients showed a 10% reduction in LVESV. The median [25th-75th] QI was 14.3% [7.2-21.4] and was significantly related to reverse remodeling (r=+0.22; 95%CI: 0.11-0.32, p=0.0001). The cut-off value of QI that best predicted LV reverse remodeling after 6months of CRT was 12.5% (sensitivity=63.6%, specificity=57.1%, area under the curve=0.633, p=0.0002). The time to the event death or cardiovascular hospitalization was significantly longer among patients with QI>12.5% (log-rank test, p=0.0155), with a hazard ratio (HR) of 0.3 [95%CI: 0.11-0.78]. In the multivariate regression model adjusted for baseline parameters, a 10% increment in QI (HR=0.61[0.44-0.83], p=0.002) remained significantly associated with CRT response. CONCLUSIONS Patients with a larger decrease in QRSd after CRT initiation showed greater echocardiographic reverse remodeling and better outcome from death or cardiovascular hospitalization. QI is an easy-to-measure variable that could be used to predict CRT response at the time of pacing site selection or pacing configuration programming.
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25
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Chen Z, Hanson B, Sohal M, Sammut E, Jackson T, Child N, Claridge S, Behar J, Niederer S, Gill J, Carr-White G, Razavi R, Rinaldi CA, Taggart P. Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and nonresponders to cardiac resynchronization therapy. Heart Rhythm 2016; 13:1898-904. [PMID: 27301781 DOI: 10.1016/j.hrthm.2016.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND The high risk of ventricular arrhythmias in patients with heart failure remains despite the benefit of cardiac resynchronization therapy (CRT). An electromechanical interaction between regional myocardial strain patterns and the electrophysiological substrate is thought to be important. OBJECTIVE We investigated the in vivo relation between left ventricular activation recovery interval (ARI), as a surrogate measure of action potential duration (APD), and local myocardial strain patterns in responders and nonresponders to CRT. METHODS ARIs were recorded from the left ventricular epicardium in 20 patients with CRT 6 weeks and 6 months post implantation. Two-dimensional speckle tracking echocardiography was performed at the same time to assess myocardial strains. Patients with ≥15% reduction in end-systolic volume at 6 months were classified as responders. RESULTS ARI decreased in responders (263 ± 46 ms vs 246 ± 47 ms, P < .01) and increased in nonresponders (235 ± 23 ms vs 261 ± 20 ms; P < .01). Time-to-peak radial, circumferential, and longitudinal strains increased in responders (41 ± 27, 35 ± 25, 56 ± 37 ms; P < .01) and decreased in nonresponders (-58 ± 26, -47 ± 26, -64 ± 27 ms; P < .01). There was a nonlinear correlation between changes in time-to-peak strain and ARIs (Spearman correlation coefficient r ≥ 0.70; P < .01). Baseline QRS duration >145 ms and QRS duration shortening with biventricular pacing were associated with ARI shortening following CRT. CONCLUSION Changes in ventricular wall mechanics predict local APD lengthening or shortening during CRT. Nonresponders have a worsening of myocardial strain and local APD. Baseline QRS duration >145 ms and QRS duration shortening with biventricular pacing identified patients who exhibited improvement in APD.
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Affiliation(s)
- Zhong Chen
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom,.
| | - Ben Hanson
- University College London, London, United Kingdom
| | - Manav Sohal
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Eva Sammut
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Tom Jackson
- King's College London, London, United Kingdom
| | - Nicholas Child
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Simon Claridge
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jonathan Behar
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | | | - Jaswinder Gill
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Gerald Carr-White
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Reza Razavi
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - C Aldo Rinaldi
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
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Rocha EA, Pereira FTM, Abreu JS, Lima JWO, Monteiro MDPM, Rocha Neto AC, Goés CVA, Farias AGP, Rodrigues Sobrinho CRM, Quidute ARP, Scanavacca MI. Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy. Arq Bras Cardiol 2015; 105:399-409. [PMID: 26559987 PMCID: PMC4633004 DOI: 10.5935/abc.20150093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/06/2015] [Indexed: 01/04/2023] Open
Abstract
Background 30-40% of cardiac resynchronization therapy cases do not achieve favorable
outcomes. Objective This study aimed to develop predictive models for the combined endpoint of cardiac
death and transplantation (Tx) at different stages of cardiac resynchronization
therapy (CRT). Methods Prospective observational study of 116 patients aged 64.8 ± 11.1 years,
68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV.
Clinical, electrocardiographic and echocardiographic variables were assessed by
using Cox regression and Kaplan-Meier curves. Results The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0
± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD),
ejection fraction < 25% and use of high doses of diuretics (HDD) increased the
risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the
first year after CRT, RVD, HDD and hospitalization due to congestive heart failure
increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively.
In the second year after CRT, RVD and FC III/IV were significant risk factors of
mortality in the multivariate Cox model. The accuracy rates of the models were
84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second
year after CRT. The models were validated by bootstrapping. Conclusion We developed predictive models of cardiac death and Tx at different stages of CRT
based on the analysis of simple and easily obtainable clinical and
echocardiographic variables. The models showed good accuracy and adjustment, were
validated internally, and are useful in the selection, monitoring and counseling
of patients indicated for CRT.
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27
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Herz ND, Engeda J, Zusterzeel R, Sanders WE, O'Callaghan KM, Strauss DG, Jacobs SB, Selzman KA, Piña IL, Caños DA. Sex differences in device therapy for heart failure: utilization, outcomes, and adverse events. J Womens Health (Larchmt) 2015; 24:261-71. [PMID: 25793483 DOI: 10.1089/jwh.2014.4980] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple studies of heart failure patients demonstrated significant improvement in exercise capacity, quality of life, cardiac left ventricular function, and survival from cardiac resynchronization therapy (CRT), but the underenrollment of women in these studies is notable. Etiological and pathophysiological differences may result in different outcomes in response to this treatment by sex. The observed disproportionate representation of women suggests that many women with heart failure either do not meet current clinical criteria to receive CRT in trials or are not properly recruited and maintained in these studies. METHODS We performed a systematic literature review through May 2014 of clinical trials and registries of CRT use that stratified outcomes by sex or reported percent women included. One-hundred eighty-three studies contained sex-specific information. RESULTS Ninety percent of the studies evaluated included ≤ 35% women. Fifty-six articles included effectiveness data that reported response with regard to specific outcome parameters. When compared with men, women exhibited more dramatic improvement in specific parameters. In the studies reporting hazard ratios for hospitalization or death, women generally had greater benefit from CRT. CONCLUSIONS Our review confirms women are markedly underrepresented in CRT trials, and when a CRT device is implanted, women have a therapeutic response that is equivalent to or better than in men, while there is no difference in adverse events reported by sex.
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Affiliation(s)
- Naomi D Herz
- Center for Devices and Radiological Health, United States Food and Drug Administration , Silver Spring, Maryland
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Azizian N, Rastgou F, Ghaedian T, Golabchi A, Bahadorian B, Khanlarzadeh V, Azizian Z, Haghjoo M. LV Dyssynchrony Assessed With Phase Analysis on Gated Myocardial Perfusion SPECT Can Predict Response to CRT in Patients With End-Stage Heart Failure. Res Cardiovasc Med 2014; 3:e20720. [PMID: 25785250 PMCID: PMC4347800 DOI: 10.5812/cardiovascmed.20720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/16/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) is an established treatment in patients with end-stage heart failure and wide QRS complex. However, about 30% of patients do not benefit from CRT (non-responder). Recent studies with tissue Doppler imaging yielded disappointing results in predicting CRT responders. Phase analysis was developed to allow assessment of LV dyssynchrony by gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (GMPS). Objectives: The aim of present study was to investigate the role of quantitative GMPS-derived LV dyssynchrony data to predict CRT responder. Patients and Methods: Thirty eligible patients for CRT implantation underwent GMPS and echocardiography. Response to CRT was evaluated six months after the device implantation. Clinical response to CRT was defined as 50 meters increase in 6-minute walking test (6-MWT) distance. Echocardiographic response to CRT was defined as ≥ 15% decrease in left ventricular end-systolic volume (LVESV). The lead position was considered concordant if it was positioned at the area of latest mechanical activation, and discordant if located outside the area of latest mechanical activation. Results: Clinical response to CRT was observed in 74% of patients. However, only 57% of patients were responder according to the echo criteria. There were statistically significant differences between CRT responders and non-responders for GMPS-derived variables, including phased histogram bandwidth (PHB), phase SD (PSD), and Entropy. Moreover, a cutoff value of 112° for PHB with a sensitivity of 72% and specificity of 70%, a cutoff value of 21° for PSD with a sensitivity of 90% and specificity of 74%, and a cutoff of 52% for Entropy with a sensitivity of 90% and a specificity of 80% were considered to discriminate responders and non-responders. CRT response was more likely in patients with concordant LV lead position compared to those with discordant LV lead position. Conclusions: GMPS-derived LV dyssynchrony variables can predict response to CRT with good sensitivity and specificity.
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Affiliation(s)
- Nasrin Azizian
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Fereydoon Rastgou
- Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Tahereh Ghaedian
- Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Allahyar Golabchi
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Behdad Bahadorian
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Vida Khanlarzadeh
- Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Zahra Azizian
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Majid Haghjoo, Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr St., Niayesh Blvd, Tehran, IR Iran. Tel: +98-2123922163, Fax: +98-2122048174, E-mail:
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Assadian Rad M, Tabarzan Baboli N, Barzigar A, Keirkhah J, Soltanipour S, Bonakdar HR, Mirbolouk F, Moladoust H. The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy. Anatol J Cardiol 2014; 15:204-8. [PMID: 25333982 PMCID: PMC5337055 DOI: 10.5152/akd.2014.5307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective: Cardiac resynchronization therapy (CRT) is introduced as a promising therapeutic option in heart failure (HF) patients with ventricular dyssynchrony. The challenge, however, is identifying the patients who are suitable candidates for this procedure. Fragmented QRS (fQRS) is associated with subendocardial fibrosis and myocardial scars. In this study, we aimed to evaluate the role of fragmented QRS complex on a routine 12-lead ECG as a predictor of response to CRT. Methods: Sixty-five consecutive patients with HF who underwent CRT, were studied. Patients’ resting 12-lead ECGs were analyzed to find presence of fQRS by a cardiologist. Echocardiographic response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume (LVESV) after CRT implantation. Response to CRT was compared between patients with and without fQRS. Results: The study group included 27 women (41.5%) and 38 men (58.5%) with a mean (±SD) age of 62±12 years. 27 patients (41.5%) had fQRS in their basal ECGs. Totally 46 patients (70.8%) responded to CRT in a way that the mean left ventricular ejection fraction (%) significantly increased, and left ventricular end diastolic volume (LVEDV) significantly decreased after CRT (p<0.001 and p=0.001 respectively). In multivariate logistic analysis, lack of fQRS was found to be a predictor of response to CRT (OR: 4.553, 95% CI: 1.345-15.418, p=0.015). Conclusion: We showed that the fQRS complex, as a sign of myocardial scar, predicts non-responsiveness to CRT. Therefore, fQRS may help selecting of CRT candidates.
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Affiliation(s)
- Mohammad Assadian Rad
- Cardiovascular Research Center, Faculty of Medicine, Guilan University of Medical Sciences; Rasht-Iran.
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Zhang H, Dai Z, Xiao P, Pan C, Zhang J, Hu Z, Chen S. The Left Ventricular Lead Electrical Delay Predicts Response to Cardiac Resynchronisation Therapy. Heart Lung Circ 2014; 23:936-42. [DOI: 10.1016/j.hlc.2014.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/15/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
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Nayar V, Khan FZ, Pugh PJ. Optimizing atrioventricular and interventricular intervals following cardiac resynchronization therapy. Expert Rev Cardiovasc Ther 2014; 9:185-97. [DOI: 10.1586/erc.10.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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32
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Takaya Y, Noda T, Nakajima I, Yamada Y, Miyamoto K, Okamura H, Satomi K, Aiba T, Kusano KF, Kanzaki H, Anzai T, Ishihara M, Yasuda S, Ogawa H, Kamakura S, Shimizu W. Electrocardiographic Predictors of Response to Cardiac Resynchronization Therapy in Patients With Intraventricular Conduction Delay. Circ J 2014; 78:71-7. [DOI: 10.1253/circj.cj-12-1569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoichi Takaya
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Ikutaro Nakajima
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Yuko Yamada
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Hideo Okamura
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Kazuhiro Satomi
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Kengo F. Kusano
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | | | | | - Masaharu Ishihara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Shiro Kamakura
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Wataru Shimizu
- Divisions of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nippon Medical School
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ARBELO ELENA, TOLOSANA JOSÉMARÍA, TRUCCO EMILCE, PENELA DIEGO, BORRÀS ROGER, DOLTRA ADELINA, ANDREU DAVID, ACEÑA MARTA, BERRUEZO ANTONIO, SITGES MARTA, MANSOUR FADI, CASTEL ÁNGELES, MATAS MARIONA, BRUGADA JOSEP, MONT LLUÍS. Fusion-Optimized Intervals (FOI): A New Method to Achieve the Narrowest QRS for Optimization of the AV and VV Intervals in Patients Undergoing Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2013; 25:283-92. [DOI: 10.1111/jce.12322] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 10/07/2013] [Accepted: 10/14/2013] [Indexed: 01/19/2023]
Affiliation(s)
- ELENA ARBELO
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - JOSÉ MARÍA TOLOSANA
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - EMILCE TRUCCO
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - DIEGO PENELA
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - ROGER BORRÀS
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - ADELINA DOLTRA
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - DAVID ANDREU
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - MARTA ACEÑA
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - ANTONIO BERRUEZO
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - MARTA SITGES
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - FADI MANSOUR
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - ÁNGELES CASTEL
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - MARIONA MATAS
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - JOSEP BRUGADA
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - LLUÍS MONT
- Cardiology Department-Thorax Institute-Hospital Clínic; University of Barcelona Institut d’ Investigació Biomèdica August Pi i Sunyer (IDIBAPS); Barcelona Spain
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Delayed intrinsicoid deflection onset in surface ECG lateral leads predicts left ventricular reverse remodeling after cardiac resynchronization therapy. Heart Rhythm 2013; 10:979-87. [DOI: 10.1016/j.hrthm.2013.03.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Indexed: 11/22/2022]
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Pees C, Glagau E, Hauser J, Michel-Behnke I. Reference values of aortic flow velocity integral in 1193 healthy infants, children, and adolescents to quickly estimate cardiac stroke volume. Pediatr Cardiol 2013; 34:1194-200. [PMID: 23344893 DOI: 10.1007/s00246-012-0628-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 12/27/2012] [Indexed: 11/27/2022]
Abstract
The aortic velocity time integral (VTI) is an echocardiographic tool used to estimate cardiac output (CO) by multiplying it with the aortic valve (AV) area and heart rate (HR). Inaccurate measurement of AV diameter will lead to squared miscalculation of CO. The aortic VTI itself can serve as a left-ventricular (LV) output parameter. The normal range of aortic VTI in adulthood is relatively stable, compared with childhood, but reference data are lacking. The aim of this study was to establish reference values of VTI in infants, children, and adolescents. A retrospective analysis of 1223 echocardiographic examinations of healthy children (age 0-20 years, body surface area [BSA] 0.11-2.23 m(2)) was performed. Data were correlated with age, BSA, and HR, and age subgroups with normal distribution were determined. Interobserver and intraobserver variability was calculated. Aortic VTI ranged from mean 13.8 cm (10.0-18.4 cm 5-95th percentile) in neonates to 25.1 cm (19.6-32.8 cm 5-95th percentile) in children >17 years of age and had a positive correlation with age (r = 0.685, p < 0.001), BSA (r = 0.645, p < 0.001) and a negative correlation with HR (r = -0.710, p < 0.001). Interobserver and intraobserver variability were excellent (3.9 ± 3.1 and 4.6 ± 3.7 %, respectively). Calculated mean values and percentile charts for the different age groups can serve as reference data to easily judge LV output in patients with or without congenital heart disease without enlargement or dysfunction of the AV.
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Affiliation(s)
- Christiane Pees
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, University Children's Hospital Vienna, Medical University Vienna, 1090 Vienna/Wien, Austria.
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Filgueiras-Rama D, Garofalo D, Gómez-Gallanti A. Letter by Filgueiras-Rama et al regarding article, "Maximal electric separation-guided placement of right ventricular lead improves responders in cardiac resynchronization defibrillator therapy" by Miranda et al. Circ Arrhythm Electrophysiol 2013; 6:e24. [PMID: 23592876 DOI: 10.1161/circep.112.000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schau T, Koglek W, Brandl J, Seifert M, Meyhöfer J, Neuss M, Grimm G, Bitschnau R, Butter C. Baseline vectorcardiography as a predictor of invasively determined acute hemodynamic response to cardiac resynchronization therapy. Clin Res Cardiol 2012; 102:129-38. [DOI: 10.1007/s00392-012-0506-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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Tamborero D, Vidal B, Tolosana JM, Sitges M, Berruezo A, Silva E, Castel M, Matas M, Arbelo E, Rios J, Villacastín J, Brugada J, Mont L. Electrocardiographic versus echocardiographic optimization of the interventricular pacing delay in patients undergoing cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2011; 22:1129-34. [PMID: 21635609 DOI: 10.1111/j.1540-8167.2011.02085.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Echocardiographic optimization of the VV interval may improve CRT response, but it is time-consuming and not routinely performed. The aim of this study was to compare the response to cardiac resynchronization therapy (CRT) when the interventricular pacing (VV) interval was optimized by tissue Doppler imaging (TDI) to CRT response when it was optimized following QRS width criteria. METHODS AND RESULTS The study included 156 consecutive CRT patients with severe heart failure and left bundle-branch block configuration. Atrioventricular interval was selected according to a pulsed Doppler assessment, and VV optimization was randomly assigned to echocardiography (ECHO group, n = 78) or electrocardiography (ECG group, n = 78). Optimal VV was defined for the ECHO group as producing the best LV intraventricular synchrony according to TDI displacement curves and for the ECG group as resulting in the narrowest QRS measured from the earliest deflection. At 6-month follow-up, percentage of echocardiographic responders (defined as neither death nor heart transplantation and a LV end-systolic volume reduction >10%) was higher in the ECG optimized group (50.0% vs 67.9%; P = 0.023), whereas clinical response (defined as neither death nor heart transplantation and >10% improvement in the 6-minute walking test) was similar in both groups (71.8% vs 73.1%; P = 0.858). CONCLUSIONS VV optimization based on QRS width obtained a higher percentage of responders in terms of LV reverse remodeling compared to the TDI method.
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Affiliation(s)
- David Tamborero
- Thorax Institute, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain
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Geng J, Wu B, Zheng L, Zhu J. Heart failure patients selection for cardiac resynchronization therapy. Eur J Intern Med 2011; 22:32-8. [PMID: 21238890 DOI: 10.1016/j.ejim.2010.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 10/27/2010] [Accepted: 11/02/2010] [Indexed: 11/19/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for refractory chronic heart failure (CHF) patients with ventricular dyssynchrony. The patient selection for this therapy remains the basis for response improvement. Various parameters, methods and technology for identification of appropriate patient are under research. The influences of age and gender, disease progress stage such as mild and late stage CHF including right ventricular dysfunction, dyssynchrony and scar identified by imaging techniques like echocardiography, magnetic resonance and nuclear imaging, and atrial fibrillation on CRT benefits were respectively discussed. This review summarizes the current advancement in these areas.
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Affiliation(s)
- Junchao Geng
- Department of Cardiology, No 1 Hospital affiliated to Medical School of Zhejiang University, Hangzhou, China
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