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Gerra L, Bonini N, Mei DA, Imberti JF, Vitolo M, Bucci T, Boriani G, Lip GYH. Cardiac resynchronization therapy (CRT) non-responders in the contemporary era: A State-of-the-Art review. Heart Rhythm 2024:S1547-5271(24)02670-5. [PMID: 38848860 DOI: 10.1016/j.hrthm.2024.05.057] [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: 04/29/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Abstract
Since 2000s CRT became a revolutionary therapy for heart failure with reduced left ventricular ejection fraction (HFrEF) and wide QRS. However, about one third of CRT recipients do not show a favorable response. This review of current literature aims to better define the concept of CRT response/non-response. The diagnosis of CRT non-responder should be viewed as a continuum, and it cannot rely solely on a single parameter. Moreover, several patients' baseline features might predict an unfavorable response. A strong collaboration between HF specialists and electrophysiologists is key to overcoming this challenge with multiple strategies. In the contemporary era, new pacing modalities, such as His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) represent a promising alternative to CRT. Observational studies demonstrated their potential; however, several limitations should be addressed. Large randomized controlled trials are needed to prove their efficacy in HFrEF with electromechanical dyssynchrony.
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Affiliation(s)
- Luigi Gerra
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide Antonio Mei
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Department of General and Specialized Surgery, Sapienza University of Rome, Italy
| | - Giuseppe Boriani
- Cardiology Division Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Tokmak F, Koivisto T, Lahdenoja O, Vasankari T, Jaakkola S, Airaksinen KEJ. Mechanocardiography detects improvement of systolic function caused by resynchronization pacing. Physiol Meas 2023; 44:125009. [PMID: 38041869 DOI: 10.1088/1361-6579/ad1197] [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: 06/16/2023] [Accepted: 12/01/2023] [Indexed: 12/04/2023]
Abstract
Objective.Cardiac resynchronization therapy (CRT) is commonly used to manage heart failure with dyssynchronous ventricular contraction. CRT pacing resynchronizes the ventricular contraction, while AAI (single-chamber atrial) pacing does not affect the dyssynchronous function. This study compared waveform characteristics during CRT and AAI pacing at similar pacing rates using seismocardiogram (SCG) and gyrocardiogram (GCG), collectively known as mechanocardiogram (MCG).Approach.We included 10 patients with heart failure with reduced ejection fraction and previously implanted CRT pacemakers. ECG and MCG recordings were taken during AAI and CRT pacing at a heart rate of 80 bpm. Waveform characteristics, including energy, vertical range (amplitude) during systole and early diastole, electromechanical systole (QS2) and left ventricular ejection time (LVET), were derived by considering 6 MCG axes and 3 MCG vectors across frequency ranges of >1 Hz, 20-90 Hz, 6-90 Hz and 1-20 Hz.Main results.Significant differences were observed between CRT and AAI pacing. CRT pacing consistently exhibited higher energy and vertical range during systole compared to AAI pacing (p< 0.05). However, QS2, LVET and waveform characteristics around aortic valve closure did not differ between the pacing modes. Optimal differences were observed in SCG-Y, GCG-X, and GCG-Y axes within the frequency range of 6-90 Hz.Significance.The results demonstrate significant differences in MCG waveforms, reflecting improved mechanical cardiac function during CRT. This information has potential implications for predicting the clinical response to CRT. Further research is needed to explore the differences in signal characteristics between responders and non-responders to CRT.
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Affiliation(s)
- Fadime Tokmak
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Tero Koivisto
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Olli Lahdenoja
- Department of Computing, University of Turku, Vesilinnantie 5, FI-20500 Turku, Finland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, Hämeentie 11, FI-20520 Turku, Finland
| | - Samuli Jaakkola
- Heart Center, Turku University Hospital, Hämeentie 11, FI-20520 Turku, Finland
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Fonderico C, Pergola V, Faccenda D, Salucci A, Comparone G, Marrese A, Ammirati G, Cocchiara L, Varriale A, Esposito G, Rapacciuolo A, Strisciuglio T. Impact of sacubitril/valsartan and gliflozins on cardiac resynchronization therapy response in ischemic and non-ischemic heart failure patients. Int J Cardiol 2023; 393:131391. [PMID: 37748521 DOI: 10.1016/j.ijcard.2023.131391] [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: 08/02/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
AIMS Angiotensin receptor-neprilysin inhibitor (ARNi) and sodium-glucose co-transporter 2 inhibitor (SGLT2i) improve outcomes in heart failure with reduced ejection fraction (HFrEF) patients, however their effects in cardiac resynchronization therapy (CRT) recipients have been scarcely explored. This study investigated whether ARNi and SGLT2i 1) improve the rate of clinical and echocardiographic CRT response and 2) have different impact based on the ischemic or non-ischemic etiology. METHODS HFrEF patients referred for CRT implant were grouped in no treatment (group 1), only ARNi (group 2) and both ARNi and SGLT2i (group 3). Clinical and echocardiographic response were evaluated at 12 months. RESULTS A total of 178 patients were enrolled. At one-year follow-up, 74.4% patients in group 2 (p = 0.031) and 88.9% in group 3 (p = 0.014) were classified as clinical responders vs 54.5% in the no treatments group. In multivariable analysis, ARNi/SGLT2i use was an independent predictor of CRT response (OR 3.72; CI 95%, 1.40-10.98; p = 0.011), confirmed in both groups 2 and 3. At 12 months, the median Δ LVEF increase was 6% and 8.5% in groups 2 and 3 respectively, vs 4.5% in group 1 (p = 0.042 and p = 0.029) with significantly more echocardiographic responders in groups 2 and 3 (76% and 78% vs 50%, p = 0.003 and p = 0.036). Significantly more ischemic HFrEF patients than non-ischemic were considered clinical and echocardiographic responders in the treatment groups. CONCLUSIONS ARNi alone or in combination with SGLT2i in CRT patients improves the clinical and echocardiographic response at 12 months. Ischemic patients seem to benefit more from these treatments.
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Affiliation(s)
- Celeste Fonderico
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Valerio Pergola
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Daniele Faccenda
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Alfonsomaria Salucci
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Gianluigi Comparone
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Aldo Marrese
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Ammirati
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Luigi Cocchiara
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Alfonso Varriale
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Antonio Rapacciuolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy..
| | - Teresa Strisciuglio
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
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Ye Y, Lv Y, Mao Y, Li L, Chen X, Zheng R, Hou X, Yu C, Gabriella C, Fu GS. Cardiovascular imaging in conduction system pacing: What does the clinician need? Pacing Clin Electrophysiol 2023; 46:548-557. [PMID: 36516139 DOI: 10.1111/pace.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Permanent pacemakers are used for symptomatic bradycardia and biventricular pacing (BVP)-cardiac resynchronization therapy (BVP-CRT) is established for heart failure (HF) patients traditionally. According to guidelines, patients' selection for CRT is based on QRS duration (QRSd) and morphology by surface electrocardiogram (ECG). Cardiovascular imaging techniques evaluate cardiac structure and function as well as identify pathophysiological substrate changes including the presence of scar. Cardiovascular imaging helps by improving the selection of candidates, guiding left ventricular (LV) lead placement, and optimization devices during the follow-up. Conduction system pacing (CSP) includes His bundle pacing (HBP) and left bundle branch pacing (LBBP) which is screwed into the interventricular septum. CSP maintains and restores ventricular synchrony in patients with native narrow QRSd and left bundle branch block (LBBB), respectively. LBBP is more feasible than HBP due to a wider target area. This review highlights the role of multimodality cardiovascular imaging including fluoroscopy, echocardiography, cardiac magnetic resonance (CMR), myocardial scintigraphy, and computed tomography (CT) in the pre-procedure assessment for CSP, better selection for CSP candidates, the guidance of CSP lead implantation, and the optimization of devices programming after the procedure. We also compare the different characteristics of multimodality imaging and discuss their potential roles in future CSP implantation.
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Affiliation(s)
- Yang Ye
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yuan Lv
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yankai Mao
- Department of Diagnostic Ultrasound and Echocardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lin Li
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xueying Chen
- Shanghai Institution of Cardiovascular Disease, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rujie Zheng
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Xiaofeng Hou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chan Yu
- Department of Diagnostic Ultrasound and Echocardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Captur Gabriella
- Institute of Cardiovascular Science, University College London, London, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Guo-Sheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Left Ventricular "Longitudinal Rotation" and Conduction Abnormalities-A New Outlook on Dyssynchrony. J Clin Med 2023; 12:jcm12030745. [PMID: 36769391 PMCID: PMC9917432 DOI: 10.3390/jcm12030745] [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: 11/17/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The complete left bundle branch block (CLBBB) results in ventricular dyssynchrony and a reduction in systolic and diastolic efficiency. We noticed a distinct clockwise rotation of the left ventricle (LV) in patients with CLBBB ("longitudinal rotation"). AIM The aim of this study was to quantify the "longitudinal rotation" of the LV in patients with CLBBB in comparison to patients with normal conduction or complete right bundle branch block (CRBBB). METHODS Sixty consecutive patients with normal QRS, CRBBB, or CLBBB were included. Stored raw data DICOM 2D apical-4 chambers view images cine clips were analyzed using EchoPac plugin version 203 (GE Vingmed Ultrasound AS, Horten, Norway). In EchoPac-Q-Analysis, 2D strain application was selected. Instead of apical view algorithms, the SAX-MV (short axis-mitral valve level) algorithm was selected for analysis. A closed loop endocardial contour was drawn to initiate the analysis. The "posterior" segment (representing the mitral valve) was excluded before finalizing the analysis. Longitudinal rotation direction, peak angle, and time-to-peak rotation were recorded. RESULTS All patients with CLBBB (n = 21) had clockwise longitudinal rotation with mean four chamber peak rotation angle of -3.9 ± 2.4°. This rotation is significantly larger than in patients with normal QRS (-1.4 ± 3°, p = 0.005) and CRBBB (0.1 ± 2.2°, p = 0.00001). Clockwise rotation was found to be correlated to QRS duration in patients with the non-RBBB pattern. The angle of rotation was not associated with a lower ejection fraction or the presence of regional wall abnormalities. CONCLUSIONS Significant clockwise longitudinal rotation was found in CLBBB patients compared to normal QRS or CRBBB patients using speckle-tracking echocardiography.
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6
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Chen X, Wu M. Heart failure with recovered ejection fraction: Current understanding and future prospects. Am J Med Sci 2023; 365:1-8. [PMID: 36084706 DOI: 10.1016/j.amjms.2022.07.018] [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: 08/23/2021] [Revised: 01/18/2022] [Accepted: 07/12/2022] [Indexed: 01/04/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is a prevalent kind of heart failure in which a significant amount of the ejection fraction can be repaired, and left ventricular remodeling and dysfunction can be reversed or even restored completely. However, a considerable number of patients still present clinical signs and biochemical features of incomplete recovery from the pathophysiology of heart failure and are at risk for adverse outcomes such as re-deterioration of systolic function and recurrence of HFrEF. Furthermore, it is revealed from a microscopic perspective that even if partial or complete reverse remodeling occurs, the morphological changes of cardiomyocytes, extracellular matrix deposition, and abnormal transcription and expression of pathological genes still exist. Patients with "recovered ejection fraction" have milder clinical symptoms and better outcomes than those with continued reduction of ejection fraction. Based on the unique characteristics of this subgroup and the existence of many unknowns, the academic community defines it as a new category-heart failure with recovered ejection fraction (HFrecEF). Because there is a shortage of natural history data for this population as well as high-quality clinical and basic research data, it is difficult to accurately evaluate clinical risk and manage this population. This review will present the current understanding of HFrecEF from the limited literature.
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Affiliation(s)
- Xi Chen
- Department of Cardiology, Affiliated Hospital of Putian University, Fujian, China
| | - Meifang Wu
- Department of Cardiology, Affiliated Hospital of Putian University, Fujian, China.
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The Interplay of PR Interval and AV Pacing Delays Used for Cardiac Resynchronization Therapy in Heart Failure Patients: Association with Clinical Response in a Retrospective Analysis of a Large Observational Study. J Pers Med 2022; 12:jpm12091512. [PMID: 36143297 PMCID: PMC9501597 DOI: 10.3390/jpm12091512] [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: 08/08/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) patients with prolonged QRS and impaired left ventricular (LV) systolic function. We aim to evaluate how the baseline PR interval is associated with outcomes (all-cause death or HF hospitalizations) and LV reverse remodeling (>15% relative reduction in LV end-systolic volume). Methods. Among 2224 patients with CRT defibrillators, 1718 (77.2%) had a device programmed at out-of-the-box settings (sensed AV delay: 100 ms and paced AV delay: 130 ms). Results. In this cohort of 1718 patients (78.7% men, mean age 66 years, 71.6% in NYHA class III/IV, LVEF = 27 ± 6%), echocardiographic assessment at 6-month follow-up showed that LV reverse remodeling was not constant as a function of the PR interval; in detail, it occurred in 56.4% of all patients but was more frequent (76.6%) in patients with a PR interval of 160 ms. In a median follow-up of 20 months, the endpoint of death or HF hospitalizations occurred in 304/1718 (17.7%) patients; in the multivariable regression analysis it was significantly less frequent when the PR interval was between 150 and 170 ms (hazard ratio = 0.79, 95% confidence interval (CI): 0.63−0.99, p = 0.046). The same PR range was associated with higher probability of CRT response (odds ratio = 2.51, 95% CI: 1.41−4.47, p = 0.002). Conclusions. In a large population of CRT patients, with fixed AV pacing delays, specific PR intervals are associated with significant benefits in terms of LV reverse remodeling and lower morbidity. These observational data suggest the importance of optimizing pacing programming as a function of the PR interval to maximize CRT response and patient outcome.
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Vectorcardiography-derived index allows a robust quantification of ventricular electrical synchrony. Sci Rep 2022; 12:9961. [PMID: 35705598 PMCID: PMC9200867 DOI: 10.1038/s41598-022-14000-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/03/2022] [Indexed: 11/25/2022] Open
Abstract
Alteration of muscle activation sequence is a key mechanism in heart failure with reduced ejection fraction. Successful cardiac resynchronization therapy (CRT), which has become standard therapy in these patients, is limited by the lack of precise dyssynchrony quantification. We implemented a computational pipeline that allows assessment of ventricular dyssynchrony by vectorcardiogram reconstruction from the patient’s electrocardiogram. We defined a ventricular dyssynchrony index as the distance between the voltage and speed time integrals of an individual observation and the linear fit of these variables obtained from a healthy population. The pipeline was tested in a 1914-patient population. The dyssynchrony index showed minimum values in heathy controls and maximum values in patients with left bundle branch block (LBBB) or with a pacemaker (PM). We established a critical dyssynchrony index value that discriminates electrical dyssynchronous patterns (LBBB and PM) from ventricular synchrony. In 10 patients with PM or CRT devices, dyssynchrony indexes above the critical value were associated with high time to peak strain standard deviation, an echocardiographic measure of mechanical dyssynchrony. Our index proves to be a promising tool to evaluate ventricular activation dyssynchrony, potentially enhancing the selection of candidates for CRT, device configuration during implantation, and post-implant optimization.
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10
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Moscoso I, Cebro-Márquez M, Martínez-Gómez Á, Abou-Jokh C, Martínez-Monzonís MA, Martínez-Sande JL, González-Melchor L, García-Seara J, Fernández-López XA, Moraña-Fernández S, González-Juanatey JR, Rodríguez-Mañero M, Lage R. Circulating miR-499a and miR-125b as Potential Predictors of Left Ventricular Ejection Fraction Improvement after Cardiac Resynchronization Therapy. Cells 2022; 11:cells11020271. [PMID: 35053387 PMCID: PMC8773679 DOI: 10.3390/cells11020271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/24/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022] Open
Abstract
Cardiac resynchronization therapy represents a therapeutic option for heart failure drug-refractory patients. However, due to the lack of success in 30% of the cases, there is a demand for an in-depth analysis of individual heterogeneity. In this study, we aimed to evaluate the prognostic value of circulating miRNA differences. Responder patients were defined by a composite endpoint of the presence of left ventricular reverse remodelling (a reduction ≥15% in telesystolic volume and an increment ≥10% in left ventricular ejection fraction). Circulating miRNAs signature was analysed at the time of the procedure and at a 6-month follow-up. An expression analysis showed, both at baseline and at follow-up, differences between responders and non-responders. Responders presented lower baseline expressions of miR-499, and at follow-up, downregulation of miR-125b-5p, both associated with a significant improvement in left ventricular ejection fraction. The miRNA profile differences showed a marked sensitivity to distinguish between responders and non-responders. Our data suggest that miRNA differences might contribute to prognostic stratification of patients undergoing cardiac resynchronization therapy and suggest that preimplant cardiac context as well as remodelling response are key to therapeutic success.
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Affiliation(s)
- Isabel Moscoso
- Cardiology Group, Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (I.M.); (M.C.-M.); (J.R.G.-J.)
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - María Cebro-Márquez
- Cardiology Group, Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (I.M.); (M.C.-M.); (J.R.G.-J.)
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
| | - Álvaro Martínez-Gómez
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
| | - Charigan Abou-Jokh
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
| | - María Amparo Martínez-Monzonís
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - José Luis Martínez-Sande
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Laila González-Melchor
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
| | - Javier García-Seara
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Xesús Alberte Fernández-López
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
| | - Sandra Moraña-Fernández
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
| | - José R. González-Juanatey
- Cardiology Group, Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (I.M.); (M.C.-M.); (J.R.G.-J.)
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Moisés Rodríguez-Mañero
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Ricardo Lage
- Cardiology Group, Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (I.M.); (M.C.-M.); (J.R.G.-J.)
- Department of Cardiology and Coronary Unit and Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research (IDIS-SERGAS), University Clinical Hospital, 15706 Santiago de Compostela, Spain; (Á.M.-G.); (C.A.-J.); (M.A.M.-M.); (J.L.M.-S.); (L.G.-M.); (J.G.-S.); (X.A.F.-L.); (S.M.-F.); (M.R.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Correspondence:
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11
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Assessment of left ventricular dyssynchrony by speckle tracking echocardiography in children with duchenne muscular dystrophy. Int J Cardiovasc Imaging 2021; 38:79-89. [PMID: 34905152 DOI: 10.1007/s10554-021-02369-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/27/2021] [Indexed: 10/19/2022]
Abstract
Prognosis of Duchenne muscular dystrophy (DMD) is related to cardiac dysfunction. Two dimensional-speckle tracking echocardiography (2D-STE) has recently emerged as a non-invasive functional biomarker for early detection of DMD-related cardiomyopathy. This study aimed to determine, in DMD children, the existence of left ventricle (LV) dyssynchrony using 2D-STE analysis. This prospective controlled study enrolled 25 boys with DMD (mean age 11.0 ± 3.5 years) with normal LV ejection fraction and 50 age-matched controls. Three measures were performed to assess LV mechanical dyssynchrony: the opposing-wall delays (longitudinal and radial analyses), the modified Yu index, and the time-to-peak delays of each segment. Feasibility and reproducibility of 2D-STE dyssynchrony were evaluated. All three mechanical dyssynchrony criteria were significantly higher in the DMD group than in healthy subjects: (1) opposing-wall delays in basal inferoseptal to basal anterolateral segments (61.4 ± 45.3 ms vs. 18.3 ± 50.4 ms, P < 0.001, respectively) and in mid inferoseptal to mid anterolateral segments (58.6 ± 35.3 ms vs. 42.4 ± 36.4 ms, P < 0.05, respectively), (2) modified Yu index (33.3 ± 10.1 ms vs. 28.5 ± 8.1 ms, P < 0.05, respectively), and (3) most of time-to-peak values, especially in basal and mid anterolateral segments. Feasibility was excellent and reliability was moderate to excellent, with ICC values ranging from 0.49 to 0.97. Detection of LV mechanical dyssynchrony using 2D-STE analysis is an easily and reproducible method in paediatric DMD. The existence of an early LV mechanical dyssynchrony visualized using 2D-STE analysis in children with DMD before the onset of cardiomyopathy represents a perspective for future paediatric drug trials in the DMD-related cardiomyopathy prevention.Clinical Trial Registration Clinicaltrials.gov NCT02418338. Post-hoc study, registered on April 16, 2015.
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12
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Fudim M, Borges-Neto S. Utility of diastolic dyssynchrony in the setting of cardiac resynchronization therapy. J Nucl Cardiol 2021; 28:2644-2646. [PMID: 31512196 DOI: 10.1007/s12350-019-01889-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Marat Fudim
- Duke University Medical Center, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Salvador Borges-Neto
- Duke University Medical Center, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA
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13
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Albumin-Bilirubin Score for Prediction of Outcomes in Heart Failure Patients Treated with Cardiac Resynchronization Therapy. J Clin Med 2021; 10:jcm10225378. [PMID: 34830658 PMCID: PMC8618562 DOI: 10.3390/jcm10225378] [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] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Liver function may be a useful indicator of response to cardiac resynchronization therapy (CRT). We aimed to investigate the clinical significance of albumin-bilirubin (ALBI) score, an assessment tool of liver function, on outcomes in heart failure (HF) patients treated with CRT. Methods: We studied 180 patients undergoing CRT. The ALBI score, derived from albumin and total bilirubin, and left ventricular ejection fraction (LVEF) were assessed before and 6 months after CRT. The patients were classified according to the ALBI score before CRT; High (>−2.60) or Low (≤−2.60) ALBI groups. The patients were then reclassified based on the ALBI score before and 6 months after CRT; High/High, High/Low, Low/High, and Low/Low ALBI groups. We evaluated the prognostic value of the ALBI score for HF deaths after CRT. Results: During a median follow-up period of 50 months, there were 41 (22.7%) HF deaths. A Cox proportional hazard analysis revealed that high ALBI scores at baseline were not related to HF deaths (hazard ratio, 1.907, p = 0.068). However, High/High ALBI scores, but not High/Low or Low/High ALBI scores, were an independent predictor of HF deaths compared with Low/Low ALBI scores (hazard ratio, 3.449, p = 0.008), implying that consistently high ALBI scores were associated with poor prognosis. The percentage change in LVEF from baseline to 6 months after CRT did not differ among the four groups, suggesting that left ventricular systolic function was not linked with the ALBI score. Conclusions: ALBI scores before and after CRT are a new indicator of CRT response, and have a predictive value for HF deaths in HF patients.
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14
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Fudim M, Dalgaard F, Fathallah M, Iskandrian AE, Borges-Neto S. Mechanical dyssynchrony: How do we measure it, what it means, and what we can do about it. J Nucl Cardiol 2021; 28:2174-2184. [PMID: 31144228 DOI: 10.1007/s12350-019-01758-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/15/2019] [Indexed: 01/14/2023]
Abstract
Left ventricular mechanical dyssynchrony (LVMD) is defined by a difference in the timing of mechanical contraction or relaxation between different segments of the left ventricle (LV). Mechanical dyssynchrony is distinct from electrical dyssynchrony as measured by QRS duration and has been of increasing interest due to its association with worse prognosis and potential role in patient selection for cardiac resynchronization therapy (CRT). Although echocardiography is the most used modality to assess LVMD, some limitations apply to this modality. Compared to echo-based modalities, nuclear imaging by gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) has clear advantages in evaluating systolic and diastolic LVMD. GSPECT MPI can determine systolic and diastolic mechanical dyssynchrony by the variability in the timing in which different LV segments contract or relax, which has prognostic impact in patients with coronary artery disease and heart failure. As such, by targeting mechanical dyssynchrony instead of electrical dyssynchrony, GSPECT MPI can potentially improve patient selection for CRT. So far, few studies have investigated the role of diastolic dyssynchrony, but recent evidence seems to suggest high prevalence and more prognostic impact than previously recognized. In the present review, we provide an oversight of mechanical dyssynchrony.
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Affiliation(s)
- Marat Fudim
- Duke University Medical Center, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Frederik Dalgaard
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Cardiology, Herlev & Gentofte Hospital, Copenhagen, Denmark
| | | | - Ami E Iskandrian
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salvator Borges-Neto
- Duke University Medical Center, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA
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15
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Azazy AS, Soliman M, Yaseen R, Mena M, Sakr H. Left ventricular dyssynchrony assessment using tissue synchronization imaging in acute myocardial infarction. Avicenna J Med 2021; 9:48-54. [PMID: 31143697 PMCID: PMC6530268 DOI: 10.4103/ajm.ajm_168_18] [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: 11/17/2022] Open
Abstract
Objectives: To assess left ventricular (LV) dyssynchrony in patients with ST elevation myocardial infarction (STEMI). Background: Mechanical synchronization disorder leads to a decrease in LV ejection fraction (LVEF) and stroke volume, an abnormal distribution of wall tension, and increase in workload during cardiac contraction. Methods: We enrolled 56 participants, 36 with acute STEMI and 20 healthy controls. The automatically color-coded time to peak myocardial velocity was measured using a 6mm sample volume, manually positioned within the two-dimensional-tissue strain image of the 12 basal and middle LV segments. Results: A significant delay was found between the septal-lateral and septal-posterior walls in patients with STEMI compared to patients in the control group (36.36 vs. −6.0ms, P = 0.036; and 42.7 vs. 23.94ms, P = 0.042, respectively). Furthermore, all segment maximum differences and all segment standard deviation (SD; dyssynchrony index) were found to be significantly higher in the STEMI group (131.28 vs. 95.45ms, P = 0.013; and 44.47 vs. 26.45ms, P = 0.001, respectively). A significant delay between the septal-lateral walls and septal-posterior walls, all segment maximum difference, and all segment SD (dyssynchrony index) were found in patients with complicated STEMI (70.89 vs. 15.83ms, P = 0.038; 57.44 vs. 19.06ms, P = 0.040; 138.11 vs. 100.0ms, P = 0.035; and 45.44 vs. 32.50ms, P = 0.021, respectively). There was a significant negative correlation between tissue synchronization imaging parameters and LVEF, and a positive correlation with LV end systolic dimension. Conclusion: Patients with acute STEMI showed significant LV dyssynchrony, which was an independent predictor of inhospital complications.
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Affiliation(s)
- Ahmed S Azazy
- Department of Cardiology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mahmoud Soliman
- Department of Cardiology, Meoufiya University Hospital, Meoufiya, Egypt
| | - Rehab Yaseen
- Department of Cardiology, Meoufiya University Hospital, Meoufiya, Egypt
| | - Morad Mena
- Department of Cardiology, Meoufiya University Hospital, Meoufiya, Egypt
| | - Haitham Sakr
- Department of Cardiology, King Saud Medical City, Riyadh, Saudi Arabia
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Correale M, Mallardi A, Tricarico L, Mazzeo P, Ferraretti A, Diella C, Romano V, Merolla G, Iacoviello M, Di Biase M, Brunetti ND. Remodelling is inversely proportional to left ventricular dimensions in a real-life population of patients with chronic heart failure after therapy with sacubitril/valsartan. Acta Cardiol 2021; 77:416-421. [PMID: 34353236 DOI: 10.1080/00015385.2021.1950371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Left ventricular (LV) remodelling is a major mechanism underlying disease progression in patients with heart failure (HF) with reduced ejection fraction (EF). Previous studies that LVEF improvement and reverse remodelling can be achieved after therapy with Sacubitril/Valsartan in real-world settings. Therefore, we sought to investigate possible predictors of LV remodelling, in particular echocardiographic parameters derived by Tissue Doppler Imaging. METHODS Patients with chronic HF, LV dysfunction (EF < 35%), NYHA class II-III were followed up between September 2016 and January 2019. All patients underwent clinical and echocardiography follow up at baseline and after 12 months of therapy with sacubitril/valsartan. RESULTS Fifty-four consecutive outpatients were enrolled in the study. At follow-up visit LVEF (38 ± 9 vs. 30 ± 5%, p < 0.0001), LVEDD (61 ± 8 vs. 62 ± 8 mm, p = 0.0085), LVESV (114 ± 57 vs. 130 ± 56 mm3, p = 0.0001), mitral regurgitation severity (1 ± 1 vs. 2 ± 1, p < 0.0001), and left atrial area (23 ± 6 vs. 24 ± 6 mm2, p = 0.0121) changed compared to the baseline value. Changes in LVEF (follow up vs baseline) correlated with baseline levels of heart rate (r = 0.24, p = 0.048), LVEDD (r= -0.33, p = 0.004), LVEDV (r= -0.39, p = 0.001), LVESV (r = 0.37, p = 0.002), and changes in LVESV (r=-0.34, p = 0.006). Correlations remained significant even after correction at multivariate analysis including age and gender. CONCLUSIONS Treatment with sacubitril/valsartan in patients with systolic dysfunction is associated with an improvement in LVEF in a real world scenario. Smaller LV volumes are associated with better reverse LV remodelling.
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Affiliation(s)
- Michele Correale
- Cardiology Department, University Hospital “Ospedali Riuniti”, Foggia, Italy
| | - Adriana Mallardi
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lucia Tricarico
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro Mazzeo
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Claudia Diella
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Valentina Romano
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppina Merolla
- Cardiology Department, University Hospital “Ospedali Riuniti”, Foggia, Italy
| | - Massimo Iacoviello
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Di Biase
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
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Wakayama Y, Nakano M, Fukuda K, Kumagai K, Sugai Y, Hirose M, Yamaguchi N, Kondo M, Kaneta T, Fukuda H, Kagaya Y, Shimokawa H. Cardiac Resynchronization Therapy for Improving Non-Uniform Thickening of Left Ventricular Wall: Assessment by Quantitative Gated Myocardial Perfusion SPECT. TOHOKU J EXP MED 2021; 251:69-79. [PMID: 32493869 DOI: 10.1620/tjem.251.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiac resynchronization therapy (CRT) improves cardiac dyssynchrony in heart failure patients with a wide QRS electrocardiogram (ECG). Assessment of left ventricular (LV) dyssynchrony using echocardiography or other imaging modalities is important to predict CRT effectiveness. In this study, we retrospectively evaluated cardiac nuclear imaging of ECG-gated myocardial perfusion single-photon emission computed tomography (SPECT) with 99mTc-sestamibi for CRT candidate (n = 120) with severe heart failure and wide QRS (> 120 msec) in ECG. To analyze LV non-uniformity, we used the quantitative gated SPECT (QGS) software to calculate changes in regional LV wall thickness during a cardiac cycle (i.e., wall thickening scores). Cardiac events (heart failure, ventricular arrhythmias and cardiac death) after CRT during 38 ± 22 (SD) months were also evaluated. In 97 of 120 patients who underwent QGS before and 6 months after CRT, CRT homogenized non-uniform wall thickening between septal and lateral of the LV especially in CRT responders. This observation was indicated as increase in the lateral deflection (XWT) of wall thickening scores before CRT and its decrease after CRT. In 120 patients with QGS before CRT, the larger XWT before CRT (≥ 16.5) predicted better prognoses after CRT. This finding was similarly observed even in patients with narrower baseline QRS (≤ 140 msec; n = 41 of 120), who usually have less benefits from CRT. In conclusion, CRT improved non-uniformity of wall thickening between the LV septal and lateral regions evaluated using QGS, which is predictive of better prognosis in the chronic phase after CRT.
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Affiliation(s)
- Yuji Wakayama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Makoto Nakano
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Koji Fukuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Koji Kumagai
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoshinao Sugai
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masanori Hirose
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Nobuhiro Yamaguchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masateru Kondo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiro Kaneta
- Diagnostic Radiology, Tohoku University Graduate School of Medicine
| | - Hiroshi Fukuda
- Department of Nuclear Medicine and Radiology, Tohoku University Institute of Development Aging and Cancer
| | - Yutaka Kagaya
- Office of Medical Education, Tohoku University School of Medicine
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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18
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Yamada S, Yoshihisa A, Hijioka N, Amami K, Kaneshiro T, Ishida T, Takeishi Y. Associations of the Prognostic Nutritional Index with the Cardiac Function and Survival after Cardiac Resynchronization Therapy. Intern Med 2021; 60:985-991. [PMID: 33116015 PMCID: PMC8079914 DOI: 10.2169/internalmedicine.5961-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective The relationship between changes in the nutritional status after cardiac resynchronization therapy (CRT) and the prognosis has not been fully elucidated. We aimed to evaluate the changes in the nutritional status as assessed by the prognostic nutritional index (PNI) and their associations with the improvement in the cardiac function and subsequent clinical outcomes. Methods The study population consisted of 119 patients with a CRT-device. They were divided into 2 groups, based on whether their PNI had increased at 6 months after CRT-device implantation (positive ΔPNI group, n=73) or not (negative ΔPNI group, n=46). The left ventricular (LV) end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were measured before and six months after CRT-device implantation. We compared the changes in the cardiac function and prevalence of adverse events (re-hospitalization due to worsening heart failure or all cause death) between the two groups. Results In the positive ΔPNI group, the LVEDV (186±93 mL vs. 149±71 mL, p<0.05) and LVESV (134±75 mL vs. 98±62 mL, p<0.05) were significantly decreased 6 months after CRT-device implantation. In addition, the LVEF (31±11% vs. 37±12%, p<0.05) was significantly increased after CRT-device implantation. In the negative ΔPNI group, no significant changes were observed in any echocardiographic parameters. During a median follow-up period of 914 days, there were 67 (56.3%) adverse events. In the Kaplan-Meier analysis, the positive ΔPNI group was associated with a lower risk of adverse events than the negative ΔPNI group (50.6% vs. 65.2%, log-rank p=0.042). Conclusion Our results suggest that improvement in the cardiac function after CRT-device implantation is associated with increases in the PNI, resulting in favorable outcomes.
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Affiliation(s)
- Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Japan
| | - Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Kazuaki Amami
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
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19
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Tomashitis B, Baicu CF, Butschek RA, Jackson GR, Winterfield J, Tedford RJ, Zile MR, Gold MR, Houston BA. Acute Hemodynamic Effects of Cardiac Resynchronization Therapy Versus Alternative Pacing Strategies in Patients With Left Ventricular Assist Devices. J Am Heart Assoc 2021; 10:e018127. [PMID: 33663225 PMCID: PMC8174219 DOI: 10.1161/jaha.120.018127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background The hemodynamic effects of cardiac resynchronization therapy in patients with left ventricular assist devices (LVADs) are uncharacterized. We aimed to quantify the hemodynamic effects of different ventricular pacing configurations in patients with LVADs, focusing on short‐term changes in load‐independent right ventricular (RV) contractility. Methods and Results Patients with LVADs underwent right heart catheterization during spontaneous respiration without sedation and with pressures recorded at end expiration. Right heart catheterization was performed at different pacemaker configurations (biventricular pacing, left ventricular pacing, RV pacing, and unpaced conduction) in a randomly generated sequence with >3 minutes between configuration change and hemodynamic assessment. The right heart catheterization operator was blinded to the sequence. RV maximal change in pressure over time normalized to instantaneous pressure was calculated from digitized hemodynamic waveforms, consistent with a previously validated protocol. Fifteen patients with LVADs who were in sinus rhythm were included. Load‐independent RV contractility, as assessed by RV maximal change in pressure over time normalized to instantaneous pressure, was higher in biventricular pacing compared with unpaced conduction (15.7±7.6 versus 11.0±4.0 s−1; P=0.003). Thermodilution cardiac output was higher in biventricular pacing compared with unpaced conduction (4.48±0.7 versus 4.38±0.8 L/min; P=0.05). There were no significant differences in heart rate, ventricular filling pressures, or atrioventricular valvular regurgitation across all pacing configurations. Conclusions Biventricular pacing acutely improves load‐independent RV contractility in patients with LVADs. Even in these patients with mechanical left ventricular unloading via LVAD who were relative pacing nonresponders (required LVAD support despite cardiac resynchronization therapy), biventricular pacing was acutely beneficial to RV contractility.
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Affiliation(s)
- Brett Tomashitis
- Department of Medicine Medical University of South Carolina Charleston SC
| | - Catalin F Baicu
- Division of CardiologyDepartment of MedicineRalph H. Johnson Department of Veterans Affairs Medical Center Charleston SC
| | - Ross A Butschek
- Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
| | - Gregory R Jackson
- Division of CardiologyDepartment of MedicineRalph H. Johnson Department of Veterans Affairs Medical Center Charleston SC.,Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
| | - Jeffrey Winterfield
- Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
| | - Ryan J Tedford
- Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
| | - Michael R Zile
- Division of CardiologyDepartment of MedicineRalph H. Johnson Department of Veterans Affairs Medical Center Charleston SC.,Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
| | - Michael R Gold
- Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
| | - Brian A Houston
- Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC
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20
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Wilcox JE, Fang JC, Margulies KB, Mann DL. Heart Failure With Recovered Left Ventricular Ejection Fraction: JACC Scientific Expert Panel. J Am Coll Cardiol 2021; 76:719-734. [PMID: 32762907 DOI: 10.1016/j.jacc.2020.05.075] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 12/25/2022]
Abstract
Reverse left ventricular (LV) remodeling and recovery of LV function are associated with improved clinical outcomes in patients with heart failure with reduced ejection fraction. A growing body of evidence suggests that even among patients who experience a complete normalization of LV ejection fraction, a significant proportion will develop recurrent LV dysfunction accompanied by recurrent heart failure events. This has led to intense interest in understanding how to manage patients with heart failure with recovered ejection fraction (HFrecEF). Because of the lack of a standard definition for HFrecEF, and the paucity of clinical data with respect to the natural history of HFrecEF patients, there are no current guidelines on how these patients should be followed up and managed. Accordingly, this JACC Scientific Expert Panel reviews the biology of reverse LV remodeling and the clinical course of patients with HFrecEF, as well as provides guidelines for defining, diagnosing, and managing patients with HFrecEF.
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Affiliation(s)
- Jane E Wilcox
- Division of Cardiovascular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - James C Fang
- Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Kenneth B Margulies
- Translational Research Center, Department of Medicine, University of Pennsylvania Pearlman School of Medicine, Philadelphia, Pennsylvania
| | - Douglas L Mann
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
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21
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Cardiovascular Imaging Applications in Clinical Management of Patients Treated with Cardiac Resynchronization Therapy. HEARTS 2020. [DOI: 10.3390/hearts1030017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular imaging techniques, including echocardiography, nuclear cardiology, multi-slice computed tomography, and cardiac magnetic resonance, have wide applications in cardiac resynchronization therapy (CRT). Our aim was to provide an update of cardiovascular imaging applications before, during, and after implantation of a CRT device. Before CRT implantation, cardiovascular imaging techniques may integrate current clinical and electrocardiographic selection criteria in the identification of patients who may most likely benefit from CRT. Assessment of myocardial viability by ultrasound, nuclear cardiology, or cardiac magnetic resonance may guide optimal left ventricular (LV) lead positioning and help to predict LV function improvement by CRT. During implantation, echocardiographic techniques may guide in the identification of the best site of LV pacing. After CRT implantation, cardiovascular imaging plays an important role in the assessment of CRT response, which can be defined according to LV reverse remodeling, function and dyssynchrony indices. Furthermore, imaging techniques may be used for CRT programming optimization during follow-up, especially in patients who turn out to be non-responders. However, in the clinical settings, the use of proposed functional indices for different imaging techniques is still debated, due to their suboptimal feasibility and reproducibility. Moreover, identifying CRT responders before implantation and turning non-responders into responders at follow-up remain challenging issues.
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22
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Sharma A, Mittal S, Aggarwal R, Chauhan MK. Diabetes and cardiovascular disease: inter-relation of risk factors and treatment. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2020. [DOI: 10.1186/s43094-020-00151-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
The diabetes mellitus prevalence is still advancing and increasingly becoming one of the globally most severe and expensive chronic illnesses. The strong correlation between diabetes as well as the most prominent reason for diabetes and death in diabetic patients is cardiovascular disorders. Health conditions like dyslipidemia, hypertension, obesity, and other factors of risk like the risk of cardiovascular are frequent in diabetic persons and raise the likelihood of heart attacks.
Main text
In particular, several researchers have found diabetes mellitus-related biochemical pathways that raise the likelihood of cardiovascular disorder in people with diabetes individually. This review describes diabetes-cardiovascular disorder relationships, explores potential therapeutic mechanisms, addresses existing treatment, care, and describes the directions for the future for study.
Conclusion
Thus, in individuals with diabetes, it is important to concentrate on cardiovascular threat variables to reduce the illness’s lasting cardiovascular complications. Further work to enhance knowledge of the disease state and its impact on cardiovascular function is required to boost medical treatment and cardiovascular disorders result in people with diabetes.
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23
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Prinzen FW, Vernooy K. Do we need to pace the bundle? Editorial comment on: Nonselective versus selective His bundle pacing: An acute intrapatient speckle tracking strain echocardiographic study by Bednarek et al. J Cardiovasc Electrophysiol 2020; 32:126-128. [PMID: 33290636 DOI: 10.1111/jce.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
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24
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Cho IJ, Uhm JS, Oh J, Nam JH, Yu HT, Kim T, Joung B, Kang SM. Left ventricular response after cardiac resynchronization therapy is related to early left atrial volume reduction. Korean J Intern Med 2020; 35:1125-1135. [PMID: 32019293 PMCID: PMC7487295 DOI: 10.3904/kjim.2018.430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/03/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/AIMS The current study aimed to elucidate a time-course change in left atrial volume after cardiac resynchronization therapy (CRT) and to verify factors associated with left atrial volume reduction (LAVR) and its prognostic implications. METHODS The records of 97 patients were retrospectively reviewed after CRT. Echocardiographic data were analyzed at baseline before CRT, at early follow-up (FU) (≤ 1 year, median 6 months), and at late FU (median 30 months). Left ventricular volume response (LVVR) was defined as 15% reduction in left ventricular (LV) end-systolic volume (ESV). LAVR was classified into two groups by the median value at early FU: LAVR (≥ 7.5%) and no LAVR (< 7.5%). RESULTS LV ESV index continuously decreased from baseline to early FU and from early FU to late FU (106.1 ± 47.4 mL/m2 vs. 87.6 ± 51.6 mL/m2 vs. 72.5 ± 57.1 mL/m2). LA volume index decreased from baseline to early FU, but there were no reductions thereafter (51.8 ± 21.9 mL/m2 vs. 45.1 ± 19.6 mL/m2 vs. 44.9 ± 23.0 mL/m2). The only echocardiographic factor associated with LAVR was change in E velocity (odds ratio [OR], 1.04; p = 0.002). Early LAVR (OR, 10.05; p = 0.002) was an independent predictor for late LVVR. CONCLUSION LAVR was related to reduction in E velocity, suggesting its relation with optimization of LV filling pressure. Early LAVR was a predictor for LVVR to CRT in long-term FU.
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Affiliation(s)
- In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Ho Nam
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Taehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Seok-Min Kang, M.D. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-8450 Fax: +82-2-2227-7722 E-mail:
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25
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Kuznetsov VA, Malishevskii LM, Todosiychuk VV, Soldatova AM. [Association of left bundle branch block definitions with response to cardiac resynchronisation therapy in patients with congestive heart failure]. ACTA ACUST UNITED AC 2020; 60:78-85. [PMID: 33155944 DOI: 10.18087/cardio.2020.7.n785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022]
Abstract
Aim To compare diagnostic significance of different criteria for complete left bundle branch block (cLBBB) in prediction of reverse left ventricular (LV) remodeling associated with cardiac resynchronization therapy (CRT).Materials and methods This study included 93 patients (men, 81.7 %; mean age at the time of implantation, 56.6±9.3 years). Achievement of a maximum decrease in LV end-systolic volume (ESV) was recorded during the entire follow-up period for evaluation of LV reversibility by CRT. Based on the dynamics of LV ESV, patients were divided into two groups, non-responders (n=27) and responders (n=66). cLBBB was determined by 9 criteria (ESC 2006 and 2013, AHA 2009, Strauss, and MIRACLE, CARE-HF, MADIT-CRT, REVERSE, and RAFT used in large multicenter studies).Results Incidence of cLBBB was significantly higher in the group of responders as demonstrated by the AHA (p=0.001), ESC 2013 (p=0.014), Strauss (p=0.002), MADIT-CRT (p=0.014), REVERSE (p=0.013), and RAFT (p<0.001) criteria. The highest specificity was shown for the AHA and RAFT (92.6 %) criteria, and the highest sensitivity and overall accuracy were shown for the Strauss (80.3 % and 72.04 %, respectively) criterium. The criteria proposed in actual clinical guidelines (AHA and ESC 2013) demonstrated a strong consistency in detecting cLBBB (κ=0.818, 95 % CI, 0.7-0.936; p<0.001). However, the Strauss and ESC 2006 / AHA / ESC 2013 showed the least consistency in identifying cLBBB. For the criteria described in large multicenter studies, consistency in detecting cLBBB was minimal in most cases. However, criteria with moderate or strong consistency were used in the studies, which results have substantiated the use of cLBBB as a selection criterium (MADIT-CRT, REVERSE, and RAFT).Conclusion The reversibility of LV remodeling associated with CRT was different in patients with cLBBB determined by different criteria. All actual cLBBB criteria (AHA, ESC 2013, and Strauss) were significantly more frequently observed in the responder group. Nevertheless, these criteria differed in their sensitivity and specificity. A number of large multicenter studies have used criteria with minimal consistency in detecting cLBBB, which should be taken into account in interpreting results of these studies.
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Affiliation(s)
- V A Kuznetsov
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Tyumen Cardiology Research Center, Tomsk, Russia
| | - L M Malishevskii
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Tyumen Cardiology Research Center, Tomsk, Russia
| | - V V Todosiychuk
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Tyumen Cardiology Research Center, Tomsk, Russia
| | - A M Soldatova
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Tyumen Cardiology Research Center, Tomsk, Russia
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26
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Miyazaki A, Matsutani H, Nakano Y, Ikeda T, Uemura H, Doi H. CRT in a congenital heart disease patient with interventricular dyssynchrony due to an RV conduction delay. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1051-1057. [PMID: 32519349 DOI: 10.1111/pace.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/22/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022]
Abstract
We encountered a unique pattern of cardiac dyssynchrony in a patient with complex congenital heart disease (heterotaxy syndrome) with a biventricular physiology and systemic left ventricle (LV). On speckle tracking echocardiography, dyssynchrony was not detected within the LV, but was noted in an interventricular fashion between the LV and right ventricle (RV). An electrophysiologic study revealed a conduction delay in the subpulmonary RV. Cardiac resynchronization therapy provided reverse cardiac remodeling and an excellent result in our patient by placing the pacing leads around the dyssynchronous lesion.
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Affiliation(s)
- Aya Miyazaki
- Congenital Heart Disease Center Tenri Hospital, Tenri, Japan.,Congenital Heart Disease Center, Nara Medical University, Nara, Japan.,Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Yuta Nakano
- Department of Clinical Engineering, Tenri Hospital, Tenri, Japan
| | - Tadashi Ikeda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan
| | - Hiraku Doi
- Congenital Heart Disease Center Tenri Hospital, Tenri, Japan
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27
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Roukoz H, Bhan A, Ravichandran A, Ahmed MM, Bhat G, Cowger J, Abdullah M, Dhawan R, Trivedi JR, Slaughter MS, Gopinathannair R. Continued versus Suspended Cardiac Resynchronization Therapy after Left Ventricular Assist Device Implantation. Sci Rep 2020; 10:2573. [PMID: 32054868 PMCID: PMC7018750 DOI: 10.1038/s41598-020-59117-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/21/2020] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) improves outcomes in heart failure patients with wide QRS complex. However, CRT management following continuous flow Left Ventricular Assist Device (LVAD) implant vary: some centers continue CRT while others turn off the left ventricular (LV) lead at LVAD implant. We sought to study the effect of continued CRT versus turning off CRT pacing following continuous flow LVAD implantation. A comprehensive retrospective multicenter cohort of 295 patients with LVAD and pre-existing CRT was studied. CRT was programmed off after LVAD implant in 44 patients. We compared their outcomes to the rest of the cohort using univariate and multivariate models. Mean age was 60 ± 12 years, 83% were males, 52% had ischemic cardiomyopathy and 54% were destination therapy. Mean follow-up was 2.4 ± 2.0 years, and mean LVAD support time was 1.7 ± 1.4 years. Patients with CRT OFF had a higher Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) mean profile (3.9 vs 3.3, p = 0.01), more secondary prevention indication for a defibrillator (64.9% vs 44.5%, p = 0.023), and more pre-LVAD ventricular arrhythmias (VA) (77% vs 60%, p = 0.048). There were no differences between the CRT OFF and CRT ON groups in overall mortality (Log rank p = 0.32, adjusted HR = 1.14 [0.54-2.22], p = 0.71), heart transplantation, cardiac and noncardiac mortality, all cause hospitalizations, hospitalizations for ICD shocks, and number and frequency of ICD shocks or anti-tachycardia pacing therapy. There were no differences in post LVAD atrial arrhythmias (AA) (Adjusted OR = 0.45 [0.18-1.06], p = 0.31) and ventricular arrhythmias (OR = 0.65 [0.41-1.78], p = 0.41). There was no difference in change in LVEF, LV end diastolic and end systolic diameters between the 2 groups. Our study suggests that turning off CRT pacing after LVAD implantation in patients with previous CRT pacing did not affect mortality, heart transplantation, device therapies or arrhythmia burden. A prospective study is needed to confirm these findings.
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Affiliation(s)
| | - Adarsh Bhan
- Advocate Christ Medical Center, Oak Lawn, IL, USA
| | | | | | - Geetha Bhat
- Advocate Christ Medical Center, Oak Lawn, IL, USA
| | | | | | - Rahul Dhawan
- University of Nebraska Medical Center, Omaha, NE, USA
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28
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Ahmed I, Loudon BL, Abozguia K, Cameron D, Shivu GN, Phan TT, Maher A, Stegemann B, Chow A, Marshall H, Nightingale P, Leyva F, Vassiliou VS, McKenna WJ, Elliott P, Frenneaux MP. Biventricular pacemaker therapy improves exercise capacity in patients with non-obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise. Eur J Heart Fail 2020; 22:1263-1272. [PMID: 31975494 PMCID: PMC7540697 DOI: 10.1002/ejhf.1722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/11/2022] Open
Abstract
AIMS Treatment options for patients with non-obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling. METHODS AND RESULTS Thirty-one patients with symptomatic non-obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8-month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2 )]. Patients were grouped on pre-specified analysis according to whether left ventricular end-diastolic volume increased (+LVEDV) or was unchanged/decreased (-LVEDV) with exercise at baseline. Twenty-nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 -LVEDV patients. Baseline peak VO2 was lower in -LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in -LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end-systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2 + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in -LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group. CONCLUSION Symptomatic patients with non-obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT00504647.
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Affiliation(s)
- Ibrar Ahmed
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK
| | - Brodie L Loudon
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Khalid Abozguia
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK.,Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Donnie Cameron
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ganesh N Shivu
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK
| | - Thanh T Phan
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK.,Cardiology Department, Royal Stoke University Hospital UHNM NHS Trust, Newcastle, UK
| | - Abdul Maher
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK
| | | | - Anthony Chow
- Department of Cardiovascular Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Howard Marshall
- Queen Elizabeth Hospital Birmingham, Welcome Trust Clinical Research Facility, Birmingham, UK
| | - Peter Nightingale
- Queen Elizabeth Hospital Birmingham, Welcome Trust Clinical Research Facility, Birmingham, UK
| | - Francisco Leyva
- Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | | | - William J McKenna
- Institute of Cardiovascular Science, University College of London, London, UK
| | - Perry Elliott
- Institute of Cardiovascular Science, University College of London, London, UK
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Fudim M, Borges-Neto S. A troubled marriage: When electrical and mechanical dyssynchrony don't go along. J Nucl Cardiol 2019; 26:1240-1242. [PMID: 29450822 DOI: 10.1007/s12350-018-1227-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Marat Fudim
- Duke Department of Medicine and Division of Cardiology, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Salvador Borges-Neto
- Duke Department of Radiology and Division of Nuclear Medicine, 2301 Erwin Road, Durham, NC, 27710, USA.
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30
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Santa-Clara H, Abreu A, Melo X, Santos V, Cunha P, Oliveira M, Pinto R, Carmo MM, Fernhall B. High-intensity interval training in cardiac resynchronization therapy: a randomized control trial. Eur J Appl Physiol 2019; 119:1757-1767. [DOI: 10.1007/s00421-019-04165-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/23/2018] [Indexed: 12/31/2022]
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Surface electrogram-guided left ventricular lead placement improves response to cardiac resynchronization therapy. Anatol J Cardiol 2019. [PMID: 29521312 PMCID: PMC5864768 DOI: 10.14744/anatoljcardiol.2018.09216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Failure to select the optimal left ventricular (LV) segment for lead implantation is one of the most important causes of unresponsiveness to the cardiac resynchronization therapy (CRT). In our study, we aimed to investigate the echocardiographic and clinical benefits of LV lead implantation guided by an intraoperative 12-lead surface electrocardiogram (ECG) in patients with multiple target veins. METHODS We included 80 [42 (62.5%) male] heart failure patients who successfully underwent CRT defibrillator (CRT-D) implantation. Patients were divided into two groups. In group 1, LV lead was positioned at the site with the shortest biventricular-paced (BiV-paced) QRS duration (QRSd), as intraprocedurally measured using surface ECG. In group 2 (control), we included patients who underwent the standard unguided CRT. ECG, echocardiogram, and functional status were evaluated before and 6 months after CRT implantation in all patients. RESULTS In group 1, BiV-paced QRSd measurements were successfully performed in 112 of 120 coronary sinus branches during CRT and an LV lead was successfully placed at the optimal site in all patients. Compared with group 2, group 1 had a significantly higher rate (85% vs. 50%, p=0.02) of response (>15% reduction in LV end-systolic volume) to CRT as well as a shorter QRSd (p<0.001) and a greater QRS shortening (ΔQRS) associated with CRT compared with baseline (p<0.001). The mean New York Heart Association functional class was significantly improved in both groups, and no significant differences were found in clinical response to CRT (85% vs. 70%, p=0.181). CONCLUSION Surface ECG can be used to guide LV lead placement in patients with multiple target veins for improving response to CRT. Thus, it is a safe, feasible, and economic approach for CRT-D implantation.
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32
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Impact of QRS Duration and Ventricular Pacing on Clinical and Arrhythmic Outcomes in Continuous Flow Left Ventricular Assist Device Recipients: A Multicenter Study. J Card Fail 2019; 25:355-363. [DOI: 10.1016/j.cardfail.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 02/04/2019] [Accepted: 02/18/2019] [Indexed: 01/29/2023]
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Nishimura M, Birgersdotter-Green U. Gender-Based Differences in Cardiac Resynchronization Therapy Response. Card Electrophysiol Clin 2019; 11:115-122. [PMID: 30717843 DOI: 10.1016/j.ccep.2018.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiac resynchronization therapy (CRT) has been shown to have a multitude of beneficial effects in select patients with systolic heart failure, by enhancing reverse remodeling, improving quality of life and functional status, reducing risk of heart failure admission, and most importantly, improving survival. Although women were underrepresented in the clinical trials, they were demonstrated to derive greater therapeutic benefit from CRT compared with men. Importantly, women were noted to derive benefit at a lesser degree of QRS prolongation than men, well below the now generally accepted cutoff of QRS ≥150 milliseconds.
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Affiliation(s)
- Marin Nishimura
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, Mail Code 7411, La Jolla, CA 92037-7411, USA
| | - Ulrika Birgersdotter-Green
- Pacemaker and ICD Services, Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9444 Medical Center Drive, MC 7411, La Jolla, CA 92037, USA.
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34
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D'Auria F, Polito MV, Vitulano G, Ciccarelli M, De Rosa R, Gigantino A, Piscione F, Galasso G. Predictors of left ventricular reverse remodeling in patients with chronic heart failure. J Cardiovasc Med (Hagerstown) 2019; 19:465-469. [PMID: 29952847 DOI: 10.2459/jcm.0000000000000679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Federica D'Auria
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno.,Department of Cardiology, A.O.U. 'San Giovanni di Dio e Ruggi D'Aragona' Hospital, Salerno, Italy
| | - Maria V Polito
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno.,Department of Cardiology, A.O.U. 'San Giovanni di Dio e Ruggi D'Aragona' Hospital, Salerno, Italy
| | - Gennaro Vitulano
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno.,Department of Cardiology, A.O.U. 'San Giovanni di Dio e Ruggi D'Aragona' Hospital, Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno.,Department of Cardiology, A.O.U. 'San Giovanni di Dio e Ruggi D'Aragona' Hospital, Salerno, Italy
| | - Roberta De Rosa
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno
| | - Alberto Gigantino
- Department of Cardiology, A.O.U. 'San Giovanni di Dio e Ruggi D'Aragona' Hospital, Salerno, Italy
| | - Federico Piscione
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno.,Department of Cardiology, A.O.U. 'San Giovanni di Dio e Ruggi D'Aragona' Hospital, Salerno, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno.,Department of Cardiology, A.O.U. 'San Giovanni di Dio e Ruggi D'Aragona' Hospital, Salerno, Italy
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Contractibility sensor signal evolution predicts cardiovascular events in patients with cardiac resynchronization therapy. Arch Cardiovasc Dis 2019; 112:22-30. [DOI: 10.1016/j.acvd.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/08/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022]
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Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:373-382. [PMID: 30603027 PMCID: PMC6309837 DOI: 10.5114/aic.2018.79867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction The study aimed to evaluate the prevalence and predictors of left ventricular (LV) reverse remodeling and its impact on long-term prognosis in patients with anterior ST-segment elevation myocardial infarction (STEMI). Aim To assess the percentage of reverse remodeling and its prognostic factors in anterior STEMI patients. Material and methods This observational study included 40 patients with first ever STEMI of the anterior wall. LV reverse remodeling was defined as the reduction of left ventricular end-systolic volume (ΔLVESV) by ≥ 10% in 3D transthoracic echocardiography (3D-TTE) at 3-month follow-up. 3D-TTE and speckle tracking imaging were performed during index hospitalization, while 3D-TTE and cardiac magnetic resonance (CMR) were performed at 3 months following the procedure. Patients were followed up for a median time of 3.4 years in order to evaluate major adverse cardiovascular events. Results Left ventricular reverse remodeling at 3-month follow-up was confirmed in 15 (37.5%) patients. The presence of reverse remodeling was predicted by lower troponin levels (unit OR = 0.86, p = 0.02), lower sum of ST-segment elevations before (unit OR = 0.87, p = 0.03) and after PCI (unit OR = 0.40, p = 0.03), lower maximal ST-segment elevation after PCI (unit OR = 0.01, p = 0.03), lower wall motion score index (unit OR 0.40, p = 0.03) and more negative anterior wall global longitudinal strain (unit OR = 0.88, p = 0.045). Nine MACE were reported in the without reverse remodeling group only. Non-significantly better event-free survival in the reverse remodeling group was demonstrated (log-rank p = 0.07). Conclusions Development of reverse modeling in patients with optimal revascularization and tailored pharmacotherapy is relatively high. Further studies are warranted in order to adjudicate its prognostic role for the prediction of adverse events.
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Naya M, Manabe O, Koyanagawa K, Tamaki N. The role of nuclear medicine in assessments of cardiac dyssynchrony. J Nucl Cardiol 2018; 25:1980-1987. [PMID: 28956317 DOI: 10.1007/s12350-017-1072-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/30/2022]
Abstract
Radionuclide imaging has an advantage for quantitative analyses of the tracer concentration and its temporal changes. Myocardial perfusion and function have been adapted for synchrony analyses. Extracted parameters have been demonstrated to measure ventricular synchrony and even to predict CRT outcomes. ERNA has the advantages of higher temporal resolution, greater reproducibility, and the volumetric analysis of both ventricles that can be applied for analyses of intraventricular synchrony and interventricular synchrony. Several software packages such as Quantitative Gated SPECT, the Emory Cardiac Toolbox, cardioREPO, and Heart Function View are available to assess the LV dyssynchrony parameters from GSPECT. A count-based method is applied to extract the amplitude and phase from each of the reconstructed GSPECT short-axis datasets throughout the cardiac cycle and then subjected to a Fourier analysis, the results of which are displayed on a polar map and histogram. Some of the parameters such as the bandwidth (expressed as the 95% width of the phase histogram) and the standard deviation of the phase are obtained by the phase histogram to assess the intraventricular synchrony. This review paper focuses on the application of the LV dyssynchrony parameters estimated by cardiac SPECT in patients with a heart disease.
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Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Hill AC, Silka MJ, Bar-Cohen Y. Cardiac Resynchronization Therapy in Pediatrics. J Innov Card Rhythm Manag 2018; 9:3256-3264. [PMID: 32477817 PMCID: PMC7252792 DOI: 10.19102/icrm.2018.090804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/27/2017] [Indexed: 12/24/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) has proven to be a powerful and effective tool in the treatment of adults with severe dilated or ischemic cardiomyopathy. A substantial portion of the adult heart failure population has severely depressed systolic function, heart failure symptoms, QRS prolongation, and left bundle branch block. Indications for CRT in adults are commonly focused on these characteristics. However, pediatric patients represent a heterogeneous group with many etiologies of heart failure and anatomic variants, with most of them not fitting the typical adult CRT criteria. The heterogeneity of the pediatric population has hindered the identification of ideal candidates for CRT, but initial experience with CRT in various groups of pediatric patients has been encouraging. This article reviews indications for and outcomes of CRT in pediatric and congenital heart disease patients.
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Affiliation(s)
- Allison C Hill
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael J Silka
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yaniv Bar-Cohen
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Sustained Cardiac Recovery Hinges on Timing and Natural History of Underlying Condition. Am J Med Sci 2018; 356:47-55. [DOI: 10.1016/j.amjms.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/14/2017] [Accepted: 02/21/2018] [Indexed: 01/12/2023]
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Gopinathannair R, Roukoz H, Bhan A, Ravichandran A, Ahmed MM, Familtsev D, Bhat G, Cowger J, Abdullah M, Sandesara C, Dhawan R, Birks EJ, Trivedi JR, Slaughter MS. Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients. J Am Heart Assoc 2018; 7:JAHA.118.009091. [PMID: 29907652 PMCID: PMC6220540 DOI: 10.1161/jaha.118.009091] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Many patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF‐LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF‐LVAD patients. Methods and Results Analysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT‐D (n=265) who underwent CF‐LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF‐LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P<0.001) and QRS duration (159±29 versus 126±34, P=0.001). Median biventricular pacing in the CRT group was 96%. During a median follow‐up of 478 days, Kaplan–Meier analysis showed no difference in survival between groups (log rank P=0.28). Multivariate Cox regression demonstrated no survival benefit with type of device (ICD versus CRT‐D; P=0.16), whereas use of amiodarone was associated with increased mortality (hazard ratio 1.77, 95% confidence interval 1.1–2.8, P=0.01). No differences were noted between CRT and ICD groups in all‐cause (P=0.06) and heart failure (P=0.9) hospitalizations, ventricular arrhythmia incidence (43% versus 39%, P=0.3), or ICD shocks (35% versus 29%, P=0.2). During follow‐up, 69 (26%) patients underwent pulse generator replacement in the CRT‐D group compared with 36 (15.5%) in the ICD group (P=0.003). Conclusions In this large, multicenter CF‐LVAD cohort, continued CRT was not associated with improved survival, hospitalizations, incidence of ventricular arrhythmia and ICD therapies, and was related to a significantly higher number of pulse generator changes.
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Affiliation(s)
| | | | - Adarsh Bhan
- Advocate Christ Medical Center, Oak Lawn, IL
| | | | | | | | - Geetha Bhat
- Advocate Christ Medical Center, Oak Lawn, IL
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Papageorgiou N, Providência R, Lambiase PD, Tousoulis D, Lloyd G, Bhattacharyya S. Does presence of left ventricular contractile reserve improve response to cardiac resynchronization therapy? An updated meta-analysis. Int J Cardiol 2018; 252:224-228. [DOI: 10.1016/j.ijcard.2017.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/26/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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Rowe MK, Kaye GC. Advances in atrioventricular and interventricular optimization of cardiac resynchronization therapy - what's the gold standard? Expert Rev Cardiovasc Ther 2018; 16:183-196. [PMID: 29338475 DOI: 10.1080/14779072.2018.1427582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is one of the most important advances in heart failure management in the last twenty years. Approximately one-third of patients appear not to respond to therapy. Although there are a number of possible mechanisms for non-response, an important factor is suboptimal atrioventricular (AV) and interventricular (VV) timing intervals. There remains controversy over whether routinely optimizing intervals is necessary and there is no agreed gold standard methodology. Optimization has classically been performed using echocardiography which has limits related to resource use, time-cost and variable reproducibility. Newer optimization methods using device-based sensors and algorithms show promise in reducing heart-failure hospitalization compared with echocardiography. Areas covered: This review outlines the rationale for optimization, the principles of AV and VV optimization, the standard echocardiographic approach and newer device-based algorithms and the evidence base for their use. Expert commentary: The incremental gains of optimization are likely to be real, but small, compared to the overall improvement gained from cardiac resynchronization itself. At this time routine optimization may not be mandatory but should be performed where there is no response to CRT. Device-based optimization algorithms appear to be practical and in some cases, deliver superior clinical outcomes compared to echocardiography.
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Affiliation(s)
- Matthew K Rowe
- a Department of Cardiology , Princess Alexandra Hospital , Brisbane , Australia.,b Faculty of Medicine , The University of Queensland , Brisbane , Australia
| | - Gerald C Kaye
- a Department of Cardiology , Princess Alexandra Hospital , Brisbane , Australia.,b Faculty of Medicine , The University of Queensland , Brisbane , Australia
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Wilcox JE, Mann DL. Beta-blockers for the treatment of heart failure with a mid-range ejection fraction: deja-vu all over again? Eur Heart J 2017; 39:36-38. [DOI: 10.1093/eurheartj/ehx663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Three-dimensional echocardiographic evaluation of mechanical dyssynchrony in systolic heart failure with narrow QRS complex. Indian Heart J 2017; 70:387-393. [PMID: 29961455 PMCID: PMC6034020 DOI: 10.1016/j.ihj.2017.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/20/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives To investigate the role of three-dimensional echocardiography (3DE) in evaluation of left ventricular mechanical dyssynchrony (LVMD) in heart failure (HF) patients with narrow QRS. Methods 143 subjects (70 with HF and narrow QRS, 23 with HF and LBBB and 50 controls) were subjected to 3DE, evaluating global and regional dyssynchrony using systolic dyssynchrony index, maximum segmental dyssynchrony and opposite segment dyssynchrony. Spatial distribution of LVMD was studied in each patient using 3DE derived regional time volume curves. Extent of LVMD in HF patients with narrow QRS was compared to those with left bundle branch block (LBBB). Results Frequency of LVMD was similar in HF patients with narrow QRS or LBBB (55.7% vs. 47.8%, p = NS). There was no difference in the severity of LVMD between these two groups (10.7 ± 6.7% vs. 12.1 ± 7.4%, p = NS). Both HF groups had significantly more dyssynchrony than controls. A scattered pattern of distribution of asynchronous segments was seen in narrow QRS patients; 33.96% of them had their earliest contracting segment, instead of delayed segment, located in areas conventionally targeted for LV pacing i.e. anterolateral, inferolateral or inferior segments. Conclusions 3DE confirmed significant dyssynchrony in > 50% HF patients with narrow QRS as demonstrated by other imaging methods. 3D distribution patterns of asynchronous segments indicate possibility of left ventricular mechanics related reasons responsible for lack of CRT responsiveness, an observation that generates hypothesis on possible reasons of CRT non-responsiveness.
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Abstract
Advances in medical and device therapies have demonstrated the capacity of the heart to reverse the failing phenotype. The development of normative changes to ventricular size and function led to the concept of reverse remodelling. Among heart failure therapies, durable mechanical circulatory support is most consistently associated with the largest degree of reverse remodelling. Accordingly, research to analyse human tissue after a period of mechanical circulatory support continues to yield a wealth of information. In this Review, we summarize the latest findings on reverse remodelling and myocardial recovery. Accumulating evidence shows that the molecular changes associated with heart failure, in particular in the transcriptome, metabalome, and extracellular matrix, persist in the reverse-remodelled myocardium despite apparent normalization of macrolevel properties. Therefore, reverse remodelling should be distinguished from true myocardial recovery, in which a failing heart regains both normal function and molecular makeup. These findings have implications for future research to develop therapies to repair fully the failing myocardium. Meanwhile, recognition by society guidelines of this new clinical phenotype, which is coming to be known as a state of heart failure remission, underscores the need to accurately define and identify reverse modelled myocardium for the establishment of appropriate therapies.
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Sharma A, Lavie CJ, Vallakati A, Garg A, Goel S, Lazar J, Fonarow GC. Changes in parameters of right ventricular function with cardiac resynchronization therapy. Clin Cardiol 2017; 40:1033-1043. [PMID: 28898433 DOI: 10.1002/clc.22762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/09/2017] [Accepted: 06/22/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Studies have shown that cardiac resynchronization therapy (CRT) significantly improves right ventricle (RV) size and function in patients with heart failure (HF). HYPOTHESIS CRT does not lead to improvement in RV function independent of baseline clinical variables. METHODS A systematic search of studies published between 1966 to August 31, 2015 was conducted using Pub Med, CINAHL, Cochrane CENTRAL and the Web of Science databases. Studies reporting tricuspid annular plane systolic excursion (TAPSE) or RV basal strain or RV long axis diameter or RV short axis diameter or RV fractional area change (FAC), before and after CRT, were identified. A meta-analysis was performed using random effects with inverse variance method to determine the pooled mean difference in various parameters of RV function after CRT. Meta-regression analysis was performed to test the relationship between change in various parameters of RV functions after CRT and covariates- age, QRS duration, and left ventricular ejection fraction (LVEF). RESULTS Thirteen studies (N=1541) were selected for final analysis. CRT therapy led to statistically significant increases in TAPSE [1.21 (95% CI 0.55-1.86; p<0.001)], RV FAC [2.26 (95% CI 0.50-4.01; p<0.001)] and basal strain [2.82 (95% CI 0.59-5.05; p<0.001)] and statistically significant decreases in mean RV long axis diameter [-2.94 (95% CI -5.07- -0.82; p=0.005)] and short axis diameter [-1.39 (95% CI -2.10- -0.67; p=0.876)] after a mean follow up period of 9 months. However, after meta-regression analysis for age, QRS duration, and baseline LVEF as covariates, there was no significant improvement in any of the parameters of RV function after CRT. CONCLUSION There was a statistically significant improvement in TAPSE, RV basal strain, RV fractional area, RV long axis and short axis with CRT. However, improvement in these echocardiographic parameters of RV function after CRT was not independent of baseline clinical variables but statistically dependent on age, QRS duration and baseline LVEF.
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Affiliation(s)
- Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York.,Institute of Cardiovascular Research and Technology, Brooklyn, New York
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana
| | - Ajay Vallakati
- Division of Cardiovascular Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Akash Garg
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Sunny Goel
- Department of Cardiovascular Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Jason Lazar
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Gregg C Fonarow
- Division of Cardiology, University of California, Los Angeles, California
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Providencia R, Barra S, Papageorgiou N, Ioannou A, Rogers D, Wongwarawipat T, Falconer D, Duehmke R, Colicchia M, Babu G, Segal OR, Sporton S, Dhinoja M, Ahsan S, Ezzat V, Rowland E, Lowe M, Lambiase PD, Agarwal S, Chow AW. Dual-site right ventricular pacing in patients undergoing cardiac resynchronization therapy: Results of a multicenter propensity-matched analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1113-1120. [PMID: 28734025 DOI: 10.1111/pace.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/26/2017] [Accepted: 06/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dual-site right ventricular pacing (Dual RV) has been proposed as an alternative for patients with heart failure undergoing cardiac resynchronization therapy (CRT) with a failure to deliver a coronary sinus (CS) lead. Only short-term hemodynamic and echocardiographic results of Dual RV are available. We aimed to assess the long-term results of Dual RV and its impact on survival. METHODS Multicenter retrospective assessment of all CRT implants during a 12-year period. Patients with failed CS lead implantation, treated with Dual RV, were followed and assessed for the primary endpoint of all-cause mortality and/or heart transplant. A control group was obtained from contemporary patients using propensity matching for all available baseline variables. RESULTS Ninety-three patients were implanted with Dual RV devices and compared with 93 matched controls. During a median of 1,273 days (interquartile range 557-2,218), intention-to-treat analysis showed that all-cause mortality and/or heart transplant was higher in the Dual RV group (adjusted hazard ratio [HR] = 1.66, 95% confidence interval [CI] 1.12-2.47, P = 0.012). As-treated analysis yielded similar results (HR = 1.97, 95% CI 1.31-2.96, P = 0.001). Cardiac device-related infections occurred seven times more frequently in the Dual RV site group (HR = 7.60, 95% CI 1.51-38.33, P = 0.014). Among Dual RV nonresponders, four had their apical leads switched off, five required an epicardial LV lead insertion, a transseptal LV lead was implanted in two, and in nine patients, after reviewing the CS venogram, a new CS lead insertion was successfully attempted. CONCLUSION Dual RV pacing is associated with worse clinical outcomes and higher complication rates than conventional CRT.
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Affiliation(s)
| | - Sergio Barra
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Adam Ioannou
- The Heart Hospital, University College of London Hospitals NHS Trust, London, UK
| | - Dominic Rogers
- The Heart Hospital, University College of London Hospitals NHS Trust, London, UK
| | | | - Debbie Falconer
- The Heart Hospital, University College of London Hospitals NHS Trust, London, UK
| | | | | | - Girish Babu
- The Heart Hospital, University College of London Hospitals NHS Trust, London, UK
| | | | - Simon Sporton
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Syed Ahsan
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | | | - Martin Lowe
- Barts Heart Centre, Barts Health NHS Trust, London, UK
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Mahfouz RA, El-Awady WS, Dewedar A. Ventricular dyssynchrony in pregnant women: A tissue Doppler study. Echocardiography 2017; 34:968-972. [PMID: 28692143 DOI: 10.1111/echo.13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the left ventricular (LV) synchronicity in pregnant women and to identify the main determinants of LV dyssynchrony in asymptomatic pregnant women. METHODS One hundred sixty-seven pregnant women consecutively and 48 age-matched nonpregnant controls were enrolled. For the assessment of LV systolic dyssynchrony, the standard deviation of the time from QRS onset to peak systolic (Tps-LV- standard deviation [SD]) velocity and the maximal difference of the time from QRS onset to peak systolic velocity (Tps-LV) from 12 segments at the apical views. For the LV diastolic dyssynchrony, the standard deviation of the time from QRS onset to peak diastolic (Tpe-LV-SD) velocity and the maximal difference of the time from QRS onset to peak diastolic velocity (Tpe-LV) were calculated. RESULTS Both systolic and diastolic dyssynchrony indexes were significantly higher in pregnant women than in the normal controls (Tps-LV; P<.01, Tps-LV-SD; P<.03, Tpe-LV, P<.05 and Tpe-LV-SD; P<.02). A total of 28 (16.8%) of the pregnant women had a dyssynchrony index above the accepted value for LV dyssynchrony (>34.4 msec). There was a significant correlation between LV dyssynchrony indexes with, multiparty, multifetal pregnancies, systolic blood pressure in pregnant women with LV dyssynchrony. Additionally LV dyssynchrony was significantly associated with elevated E/e" and brain natriuretic peptide (BNP). CONCLUSIONS Both systolic synchronicity and diastolic synchronicity were affected in pregnant women compared to nonpregnant women. LV dyssynchrony was significantly correlated with age, multiparity, and BNP level. Early detectable changes in systolic and diastolic synchrony may be present in pregnant women at higher risk of peripartum cardiomyopathy.
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Affiliation(s)
- Ragab A Mahfouz
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
| | | | - Ashraf Dewedar
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
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Should women have different ECG criteria for CRT than men? J Cardiol 2017; 70:1-6. [DOI: 10.1016/j.jjcc.2016.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022]
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50
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Rastogi A, Novak E, Platts AE, Mann DL. Epidemiology, pathophysiology and clinical outcomes for heart failure patients with a mid-range ejection fraction. Eur J Heart Fail 2017; 19:1597-1605. [PMID: 29024350 DOI: 10.1002/ejhf.879] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS Heart failure (HF) patients with a mid-range ejection fraction (HFmrEF) are not well characterized. Accordingly, we examined the epidemiology, pathophysiology and clinical outcomes of HF patients with a left ventricular ejection fraction (LVEF) of 40-50%. METHODS AND RESULTS We identified 168 patients with an LVEF between 40-50% at enrollment into a HF registry, and determined whether LVEF was improved, worsened, or the same compared to a prior LVEF. Three subgroups of HFmrEF patients were identified: HFmrEF improved (prior LVEF <40%); HFmrEF deteriorated (prior LVEF >50%); HFmrEF unchanged (prior LVEF 40-50%). The majority of patients (73%) were HFmrEF improved, 17% were HFmrEF deteriorated, and 10% were HFmrEF unchanged. The demographics of the HFmrEF cohort were heterogeneous, with more coronary artery disease in the HFmrEF improved group and more hypertension and diastolic dysfunction in the HFmrEF deteriorated group. HFmrEF improved patients had significantly (P<0.001) better clinical outcomes relative to matched patients with HF and reduced ejection fraction, and significantly (P<0.01) improved clinical outcomes relative to HFmrEF deteriorated patients, whereas clinical outcomes of the HFmrEF deteriorated subgroup of patients were not significantly different from matched HF patients with preserved ejection fraction. CONCLUSIONS Patients with a mid-range LVEF are heterogeneous. Obtaining historical information with regard to prior LVEF allows one to identify a distinct pathophysiological substrate and clinical course for HFmrEF patients. Viewed together, these results suggest that in the modern era of HF therapeutics, the use of LVEF to categorize the pathophysiology of HF may be misleading, and argue for establishing a new taxonomy for classifying HF patients.
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Affiliation(s)
- Ashish Rastogi
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Novak
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne E Platts
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Douglas L Mann
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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