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Molina KM, Shrader P, Colan SD, Mital S, Margossian R, Sleeper LA, Shirali G, Barker P, Canter CE, Altmann K, Radojewski E, Tierney ESS, Rychik J, Tani LY. Predictors of disease progression in pediatric dilated cardiomyopathy. Circ Heart Fail 2013; 6:1214-22. [PMID: 24132734 DOI: 10.1161/circheartfailure.113.000125] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite medical advances, children with dilated cardiomyopathy (DCM) remain at high risk of death or need for cardiac transplantation. We sought to identify predictors of disease progression in pediatric DCM. METHODS AND RESULTS The Pediatric Heart Network evaluated chronic DCM patients with prospective echocardiographic and clinical data collection during an 18-month follow-up. Inclusion criteria were age <22 years and DCM disease duration >2 months. Patients requiring intravenous inotropic/mechanical support or listed status 1A/1B for transplant were excluded. Disease progression was defined as an increase in transplant listing status, hospitalization for heart failure, intravenous inotropes, mechanical support, or death. Predictors of disease progression were identified using Cox proportional hazards modeling and classification and regression tree analysis. Of the 127 patients, 28 (22%) had disease progression during the 18-month follow-up. Multivariable analysis identified older age at diagnosis (hazard ratio=1.14 per year; P<0.001), larger left ventricular (LV) end-diastolic M-mode dimension z-score (hazard ratio=1.49; P<0.001), and lower septal peak systolic tissue Doppler velocity z-score (hazard ratio=0.81; P=0.01) as independent predictors of disease progression. Classification and regression tree analysis stratified patients at risk of disease progression with 89% sensitivity and 94% specificity based on LV end-diastolic M-mode dimension z-score ≥7.7, LV ejection fraction <39%, LV inflow propagation velocity (color M-mode) z-score <-0.28, and age at diagnosis ≥8.5 months. CONCLUSIONS In children with chronic stable DCM, a combination of diagnosis after late infancy and echocardiographic parameters of larger LV size and systolic and diastolic function predicted disease progression. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00123071.
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Tani T, Sumida T, Tanabe K, Ehara N, Yamaguchi K, Kawai J, Yagi T, Morioka S, Fujiwara H, Okada Y, Kita T, Furukawa Y. Left Ventricular Systolic Dyssynchrony Index by Three-Dimensional Echocardiography in Patients with Decreased Left Ventricular Function: Comparison with Tissue Doppler Echocardiography. Echocardiography 2011; 29:346-52. [DOI: 10.1111/j.1540-8175.2011.01577.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ishikawa T. Limitations and Problems of Assessment of Mechanical Dyssynchrony in Determining Cardiac Resynchronization Therapy Indication - Is Assessment of Mechanical Dyssynchrony Necessary in Determining CRT Indication? (Con) -. Circ J 2011; 75:465-71. [DOI: 10.1253/circj.cj-10-1252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Tanaka Y, Tada H, Yamashita E, Sato C, Irie T, Hori Y, Goto K, Iwamoto J, Manni H, Yokokawa M, Naito S, Oshima S, Taniguchi K. Change in Blood Pressure Just After Initiation of Cardiac Resynchronization Therapy Predicts Long-Term Clinical Outcome in Patients With Advanced Heart Failure. Circ J 2009; 73:288-94. [DOI: 10.1253/circj.cj-08-0553] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yasuaki Tanaka
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Chizuru Sato
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Tadanobu Irie
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Yasuhiko Hori
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Jotaro Iwamoto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hiroki Manni
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Miki Yokokawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shigeru Oshima
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
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Takamatsu H, Tada H, Okaniwa H, Toide H, Maruyama H, Higuchi R, Kaseno K, Naito S, Kurabayashi M, Oshima S, Taniguchi K. Right Bundle Branch Block and Impaired Left Ventricular Function as Evidence of a Left Ventricular Conduction Delay. Circ J 2008; 72:120-6. [DOI: 10.1253/circj.72.120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hiroki Okaniwa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hiroyuki Toide
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hiroko Maruyama
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Rumi Higuchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Masahiko Kurabayashi
- Gunma University Graduate School of Medicine, Department of Medicine and Biological Science
| | - Shigeru Oshima
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
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Mullens W, Tang WW, Grimm RA. Using echocardiography in cardiac resynchronization therapy. Am Heart J 2007; 154:1011-20. [PMID: 18035069 DOI: 10.1016/j.ahj.2007.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022]
Abstract
Cardiac resynchronization therapy has become a therapeutic option for refractory heart failure. Several imaging techniques play an increasingly important role in patient selection during and after implantation. This manuscript reviews the current echocardiographic techniques available for guiding both patient selection and optimization of device programming following implantation.
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Akagawa E, Murata K, Tanaka N, Yamada H, Miura T, Kunichika H, Wada Y, Hadano Y, Tanaka T, Nose Y, Yasumoto K, Kono M, Matsuzaki M. Augmentation of left ventricular apical endocardial rotation with inotropic stimulation contributes to increased left ventricular torsion and radial strain in normal subjects: quantitative assessment utilizing a novel automated tissue tracking technique. Circ J 2007; 71:661-8. [PMID: 17456988 DOI: 10.1253/circj.71.661] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The difference in the left ventricular (LV) torsion of the endo- and epicardium (Endo, Epi) with inotropic stimulation and its relation to radial strain (RS) remain unclear. METHODS AND RESULTS LV basal and apical short-axis images were recorded in 13 normal subjects at rest and during dobutamine infusion (5, 10 microg x kg (-1) x min(-1)). A total of 8 points (anterior, lateral, posterior and septum in both Endo and Epi) were manually placed by 2-dimensional tissue tracking technique and the movement of these points during a cardiac cycle was tracked, after which the rotation angles and RS were calculated. LV torsion was defined as the net difference between the basal and apical rotations. In the LV apex, Endo-rotation increased (7.8+/-2.7 to 14.1+/-4.6 degrees, p<0.01), whereas Epi-rotation was unchanged, with dobutamine. The apical Endo-rotation was significantly greater than the Epi-rotation, although no difference was seen between the Endo and Epi in the LV base throughout the study. During dobutamine infusion, the LV Endo-torsion increased (9.5+/-2.8 to 19.3+/-4.8 degrees, p<0.01) and these values were greater than those for Epi. The apical RS increased with the dobutamine dose (39.0+/-9.3 to 61.9+/-15.5%, p<0.01), whereas basal RS initially increased at 5 microg x kg(-1) x min(-1), but thereafter showed no further increase at 10 microg x kg(-1) x min(-1) of dobutamine. CONCLUSIONS Augmentation of LV rotation with inotropism was clearly observed in the apical Endo, thus causing increased LV endo-torsion and apical RS.
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Affiliation(s)
- Eizo Akagawa
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Inoue N, Takahashi N, Ishikawa T, Sumita S, Kobayashi T, Matsushita K, Matsumoto K, Taima M, Shimura M, Uchino K, Kimura K, Inoue T, Umemura S. Reverse perfusion-metabolism mismatch predicts good prognosis in patients undergoing cardiac resynchronization therapy: a pilot study. Circ J 2007; 71:126-31. [PMID: 17186990 DOI: 10.1253/circj.71.126] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves glucose metabolism in the septum of patients with heart failure, so in the present study the predictive value of combined fluorodeoxyglucose (FDG)-positron emission tomography (PET) and metoxy-isobutyl isonitrile (MIBI)-single photon emission computed tomography (SPECT) for the prognosis of patients undergoing CRT was investigated. METHODS AND RESULTS Fourteen patients (70.3+/-8.2 years) who underwent FDG-PET and MIBI-SPECT before implantation of a biventricular pacemaker were enrolled. The total number of matches, mismatches, reverse mismatches, summed difference score (SDS: sum total of FDG - MIBI scores) and SDS per segment (%SDS) in each of 5 areas of myocardium (septum, anterior, lateral, inferior area, apex) was calculated and compared between the survival groups (all survival: survival group; survival without ischemic heart disease (IHD): non-IHD survival group) and non-survival group. Both the number of reverse mismatch segments and the %SDS in the septum in the non-IHD survival group were significantly greater than in the non-survival group (3.2+/-1.6 vs 0.5+/-0.6, p<0.05; 0.62+/-0.61 vs -0.11+/-0.19, p<0.05). The receiver-operating characteristics curves for prognosis showed that the area under the curve for the number of reverse mismatch segments in the septum (0.93; confidence interval 0.61-0.98) was significantly greater. CONCLUSION A reverse mismatch pattern in the septum can predict a good prognosis for patients treated with CRT.
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Affiliation(s)
- Noriko Inoue
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan.
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Burri H, Lerch R. Echocardiography and patient selection for cardiac resynchronization therapy: A critical appraisal. Heart Rhythm 2006; 3:474-9. [PMID: 16567299 DOI: 10.1016/j.hrthm.2005.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 12/02/2005] [Indexed: 11/27/2022]
Abstract
Echocardiography has been the focus of growing interest for improving patient selection for cardiac resynchronization therapy in order to reduce the number of nonresponders. Various techniques have been described for assessing dyssynchrony, using standard echocardiography (pulsed-wave Doppler and M-mode echocardiography), tissue Doppler imaging, and other imaging modes such as three-dimensional echocardiography. This article provides an overview of the technical and practical aspects of these different techniques and discusses the current evidence for optimizing patient selection by echocardiography.
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Affiliation(s)
- Haran Burri
- Cardiology Service, University Hospital of Geneva, Switzerland.
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Muramatsu T, Matsumoto K, Nishimura S. Efficacy of the phase images in Fourier analysis using gated cardiac POOL-SPECT for determining the indication for cardiac resynchronization therapy. Circ J 2006; 69:1521-6. [PMID: 16308502 DOI: 10.1253/circj.69.1521] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) improves quality of life and survival for patients with heart failure, exact methods to estimate the effect of cardiac asynchrony have not yet been defined. METHODS AND RESULTS Initially, to examine whether the phase analysis images in the Fourier analysis using gated cardiac pool single photon emission computed tomography (POOL-SPECT) could be used to evaluate cardiac asynchrony, 19 consecutive patients with dilated cardiomyopathy were studied. Interventricular asynchrony was defined by whether the peak of the picture elements of the right ventricle in the phase histogram fitted that of the left ventricle and intraventricular asynchrony by whether the phase image was described homogenously or not. The patients with both inter- and intraventricular asynchrony had significant deterioration in both left ventricular ejection fraction (p<0.01) and New York Heart Association functional class (p<0.01). To evaluate the efficacy of these phase images for CRT setting, 7 patients were tested before and after CRT. During a 3.9+/-3.6 month follow-up period, all patients had an improvement in their condition, and the inter- and intraventricular asynchrony significantly improved after CRT. The degrees of the inter- and intraventricular asynchrony were related to the degree of cardiac depression pre CRT. CONCLUSION These results have shown that the phase images from POOL-SPECT are useful for assessing the effect of CRT in patients with heart failure, which suggests that it may provide information about the indication for CRT.
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Higuchi K, Toyama T, Tada H, Naito S, Ohshima S, Kurabayashi M. Usefulness of Biventricular Pacing to Improve Cardiac Symptoms, Exercise Capacity and Sympathetic Nerve Activity in Patients With Moderate to Severe Chronic Heart Failure. Circ J 2006; 70:703-9. [PMID: 16723791 DOI: 10.1253/circj.70.703] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although cardiac resynchronization using biventricular pacing (BVP) results in significant clinical improvement in patients with chronic heart failure (CHF), there is no evidence of improvement in sympathetic nerve activity (SNA). METHODS AND RESULTS Eighteen patients with CHF (dilated cardiomyopathy/ischemic cardiomyopathy =14/4) and left ventricular (LV) ejection fraction <40%, QRS duration >160 ms and dyssynchronous LV wall motion were classified into 2 groups based on the findings of (99m)Tc-methoxyisobutyl isonitrile (MIBI) quantitative gated single-photon emission computed tomography (SPECT) (QGS). Resynchronization was considered to be present when the difference between the QGS frame number for end-systole for the LV septal and lateral walls (dyssynchrony index) disappeared. Group A achieved resynchronization after BVP, but not Group B. In group A, New York Heart Association functional class (p=0.0002), specific activity scale (p=0.0001), total defect score (p<0.05), and the heart/mediastinum ratio of delayed (123)I-metaiodobenzylguanidine imaging (p<0.05) were significantly improved after resynchronization. However, there was no significant change in group B. CONCLUSIONS Cardiac resynchronization after BVP can improve cardiac symptoms, exercise capacity, and SNA in patients with moderate to severe CHF.
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Affiliation(s)
- Kyosuke Higuchi
- Department of Medicine and Biological Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
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