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Dong JX, Wei L, Jin LX, He J, Zhao CX, Ding S, Kong LC, Yang F, An DAL, Wu CW, Chen BH, Wang HW, Yang YN, Ge H, Pu J. MR Uniformity Ratio Estimates to Evaluate Ventricular Mechanical Dyssynchrony and Prognosis After ST-Segment Elevation Myocardial Infarction. J Magn Reson Imaging 2024; 59:1820-1831. [PMID: 37830268 DOI: 10.1002/jmri.28998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The impact of left ventricular mechanical dyssynchrony (LVMD) on the long-term prognosis of ST-segment elevation myocardial infarction (STEMI) is unclear. HYPOTHESIS MR uniformity ratio estimates (URE) can detect LVMD and assess STEMI prognosis. STUDY TYPE Retrospective analysis of a prospective multicenter registry (EARLY-MYO trial, NCT03768453). POPULATION Overall, 450 patients (50 females) with first-time STEMI were analyzed, as well as 40 participants without cardiovascular disease as controls. FIELD STRENGTH/SEQUENCE 3.0-T, balanced steady-state free precession cine and late gadolinium enhancement imaging. ASSESSMENT MRI data were acquired within 1 week of symptom onset. Major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal re-infarction, hospitalization for heart failure, and stroke, were the primary clinical outcomes. LVMD was represented by circumferential URE (CURE) and radial URE (RURE) calculated using strain measurements. The patients were grouped according to clinical outcomes or URE values. Patients' clinical characteristics and MR indicators were compared. STATISTICAL TESTS The Student's t-test, Mann-Whitney U test, chi-square test, Fisher's exact test, receiver operating characteristic curve analysis with area under the curve, Kaplan-Meier analysis, Cox regression, logistic regression, intraclass correlation coefficient, c-index, and integrated discrimination improvement were used. P < 0.05 was considered statistically significant. RESULTS CURE and RURE were significantly lower in patients with STEMI than in controls. The median follow-up was 60.5 months. Patients with both lower CURE and RURE values experienced a significantly higher incidence of MACEs by 3.525-fold. Both CURE and RURE were independent risk factors for MACEs. The addition of UREs improved diagnostic efficacy and risk stratification based on infarct size and left ventricular ejection fraction (LVEF). The indicators associated with LVMD included male sex, serum biomarkers (peak creatine phosphokinase and cardiac troponin I), infarct size, and LVEF. DATA CONCLUSION CURE and RURE may be useful to evaluate long-term prognosis after STEMI. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jian-Xun Dong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lai Wei
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Xing Jin
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen-Xu Zhao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Song Ding
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ling-Cong Kong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Yang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Ao-Lei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chong-Wen Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hu-Wen Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi-Ning Yang
- People's Hospital of Xinjiang Uygur Autonomous Region, Wulumuqi, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Khor J, Diaz-Canestro C, Chan KY, Guo M, Montero D. Blood volume contributes to the mechanical synchrony of the myocardium during moderate and high intensity exercise in women. Eur J Appl Physiol 2024; 124:1227-1237. [PMID: 37985476 DOI: 10.1007/s00421-023-05355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Whether blood volume (BV) primarily determines the synchronous nature of the myocardium remains unknown. This study determined the impact of standard blood withdrawal on left ventricular mechanical dyssynchrony (LVMD) in women. METHODS Transthoracic speckle-tracking echocardiography and central hemodynamic measurements were performed at rest and during moderate- to high-intensity exercise in healthy women (n = 24, age = 53.6 ± 16.3 year). LVMD was determined via the time to peak standard deviation (TPSD) of longitudinal and transverse strain and strain rates (LSR, TSR). Measurements were repeated within a week period immediately after a 10% reduction of BV. RESULTS With intact BV, all individuals presented cardiac structure and function variables within normative values of the study population. Blood withdrawal decreased BV (5.3 ± 0.7 L) by 0.5 ± 0.1 L. Resting left ventricular (LV) end-diastolic volume (- 8%, P = 0.040) and passive filling (- 16%, P = 0.001) were reduced after blood withdrawal. No effect of blood withdrawal was observed for any measure of LVMD at rest (P ≥ 0.225). During exercise at a fixed submaximal workload (100 W), LVMD of myocardial longitudinal strain (LS TPSD) was increased after blood withdrawal (36%, P = 0.047). At peak effort, blood withdrawal led to increased LVMD of myocardial transverse strain rate (TSR TPSD) (31%, P = 0.002). The effect of blood withdrawal on TSR TPSD at peak effort was associated with LV concentric remodeling (r = 0.59, P = 0.003). CONCLUSION Marked impairments in the mechanical synchrony of the myocardium are elicited by moderate blood withdrawal in healthy women during moderate and high intensity exercise.
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Affiliation(s)
- Joyce Khor
- Faculty of Medicine, Institute of Cardiovascular Medicine and Science, University of Hong Kong, Hong Kong SAR, China
| | | | - Koot Yin Chan
- Faculty of Medicine, Institute of Cardiovascular Medicine and Science, University of Hong Kong, Hong Kong SAR, China
| | - Meihan Guo
- Faculty of Medicine, Institute of Cardiovascular Medicine and Science, University of Hong Kong, Hong Kong SAR, China
| | - David Montero
- Faculty of Medicine, Institute of Cardiovascular Medicine and Science, University of Hong Kong, Hong Kong SAR, China.
- Institute of Cardiovascular Science and Medicine, University of Hong Kong, Hong Kong, China.
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
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Chan KY, Diaz-Canestro C, Guo M, Montero D. Impaired cardiac mechanical synchrony revealed with increased myocardial work in women with advanced age. Exp Gerontol 2023; 172:112073. [PMID: 36572258 DOI: 10.1016/j.exger.2022.112073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether the synchronous nature of the myocardium is sex-dependent or affected by the aging process remains unknown. This study aimed to determine the influence of sex and age on cardiac mechanical synchrony during controlled hemodynamic stress. METHODS Transthoracic speckle-tracking echocardiography analyses and central hemodynamics were assessed at rest and during moderate- to high-intensity exercise in healthy young (<45 yr) and older (≥45 yr) women (n = 32) and men (n = 34) matched by age, physical activity and exercise capacity. Left ventricular mechanical dyssynchrony (LVMD) was determined as the time to peak standard deviation (TPSD) of longitudinal and transverse strain and strain rates (LSR, TSR). RESULTS Physical activity, aerobic capacity, heart rate, blood pressure and LVMD at rest were similar between women and men in each age group (P > 0.05). The rate pressure product, an index of myocardial work, did not differ between sex and age groups at rest and during exercise at a given percentage of peak heart rate (P > 0.05). A consistent age effect was observed for transverse LVMD (P-for-age ≤ 0.011). Specifically, older women presented with marked increments (≥42 %) in TSR TPSD at all exercise levels compared with younger women (P ≤ 0.005). Sex per se did not generally affect LVMD. CONCLUSION A prevailing impairment of cardiac mechanical synchrony in the transverse axis of the left ventricle is revealed during conditions of elevated hemodynamic stress in women with advanced age.
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Affiliation(s)
- Koot Yin Chan
- Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong
| | | | - Meihan Guo
- Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong
| | - David Montero
- Faculty of Medicine, School of Public Health, University of Hong Kong, Hong Kong; Institute of Cardiovascular Science and Medicine, University of Hong Kong, Hong Kong; Libin Cardiovascular Institute of Alberta, University of Calgary, Canada.
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Marzlin N, Hays AG, Peters M, Kaminski A, Roemer S, O'Leary P, Kroboth S, Harland DR, Khandheria BK, Tajik AJ, Jain R. Myocardial Work in Echocardiography. Circ Cardiovasc Imaging 2023; 16:e014419. [PMID: 36734221 DOI: 10.1161/circimaging.122.014419] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Myocardial work is an emerging tool in echocardiography that incorporates left ventricular afterload into global longitudinal strain analysis. Myocardial work correlates with myocardial oxygen consumption, and work efficiency can also be assessed. Myocardial work has been evaluated in a variety of clinical conditions to assess the added value of myocardial work compared to left ventricular ejection fraction and global longitudinal strain. This review showcases the current use of myocardial work in adult echocardiography and its possible role in cardiac pathologies.
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Affiliation(s)
- Nathan Marzlin
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Allison G Hays
- Johns Hopkins School of Medicine, Baltimore, MD (A.G.H.)
| | - Matthew Peters
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Patrick O'Leary
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Stacie Kroboth
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin (S.K.)
| | - Daniel R Harland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
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Tejman-Yarden S, Barzilai DH, Ertracht O, Bachner-Heinenzon N, Bogdan S, Katz U, Chatterji S, Dray EM, Bolkier Y, Glikson M, Beinart R. Comparison of Speckle Tracking Echocardiography During Different Pacing Modalities for Cardiac Resynchronization Therapy Response Prediction. Heart Int 2022; 16:64-70. [DOI: 10.17925/hi.2022.16.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study was to evaluate left ventricular mechanical activation pattern by speckle tracking echocardiography (STE) as a predictor of response to cardiac resynchronization therapy (CRT) in patients with heart failure. Methods: Echocardiography was performed during no pacing, right ventricular pacing (RVP), biventricular pacing (BVP) and multipolar pacing (MPP) immediately after CRT implantation in 16 patients at a single centre. Seven patients were diagnosed as responders and 9 patients as non-responders after 6 months of standard CRT pacing. All had adequate short axis views, and 1 CRT responder and 2 CRT non-responders had limited longitudinal views. Results: Longitudinal and circumferential global strain (GS) and global strain rate (GSR) or their change analysis, did not yield any CRT response prediction. However, the longitudinal BVP/RVP GS ratio was significantly higher in the responder group (1.32 ± 0.2%, 2.0 ± 0.4% and 1.9 ± 0.4%), compared with the non-responder group (1.06 ± 0.2%, 1.1 ± 0.4% and 1.2 ± 0.4%) in the apical two-chamber, APLAX and four-chamber views, respectively. Similarly, the longitudinal BVP/RVP GSR at active systolic phase (GSRs) was significantly higher in the responder group (1.9 ± 0.9% and 1.7 ± 0.4%) compared with the non-responder group (1.0 ± 0.4% and 1.1 ± 0.2%) in the apical APLAX and four-chamber views, respectively. Measurements of the strain delay index showed predictive power regarding CRT response in non-paced patients. Conclusion: Post implantation, longitudinal BVP/RVP GS and GSRs ratios of 1.4% and above may be useful as a CRT response prediction tool. Furthermore, our findings support the usefulness of strain delay index prior to CRT implantation in non-paced patients.
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Miyajima K, Urushida T, Ito K, Kin F, Okazaki A, Takashima Y, Watanabe T, Kawaguchi Y, Wakabayashi Y, Takehara Y, Maekawa Y. Four-dimensional flow magnetic resonance imaging visualizes reverse vortex pattern and energy loss increase in left bundle branch block. Europace 2021; 24:1284-1290. [PMID: 34919657 DOI: 10.1093/europace/euab299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/27/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS This study aimed to investigate the intraventricular blood flow pattern of patients with left bundle branch block (LBBB) using four-dimensional flow magnetic resonance imaging (4D-flow MRI). METHODS AND RESULTS We performed 4D-flow MRI for 16 LBBB patients (LBBB group) and 16 propensity score-matched patients with a normal QRS duration (non-LBBB group). The energy loss (EL) in the left ventricle was evaluated. In both groups, blood flow from the mitral valve to the apex of the heart and left ventricular (LV) outflow tract during LV diastole were observed. Vortices were also observed in both groups. There were two patterns of vortices: unidirectional clockwise rotation and counterclockwise rotation taking place from the mid-diastole to the systole (reverse pattern). The reverse pattern was observed significantly more frequently in the LBBB group (LBBB 94% vs. non-LBBB 19%, P < 0.001). The interobserver agreement for the streamline analysis was good (kappa = 0.68). The maximum EL was significantly higher in the LBBB group [LBBB 12 (11-15) mW vs. non-LBBB 8.0 (6.2-9.7) mW, P < 0.001]. CONCLUSION Left bundle branch block patients may suffer from inefficient LV haemodynamics reflected by non-physiological counterclockwise vortices and increased EL. Thus, the shape of the vortices and EL in the left ventricle can serve as markers of LV mechanical dyssynchrony in LBBB patients and could be investigated as predictors of response to cardiac resynchronization therapy.
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Affiliation(s)
- Keisuke Miyajima
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan
| | - Tsuyoshi Urushida
- Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazuki Ito
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan
| | - Fumihiko Kin
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan
| | - Ayako Okazaki
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan
| | - Yasuyo Takashima
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan
| | - Tomoyuki Watanabe
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan
| | - Yoshitaka Kawaguchi
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan
| | - Yasushi Wakabayashi
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yuichiro Maekawa
- Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Grandperrin A, Schuster I, Rupp T, Izem O, Obert P, Nottin S. Left ventricular dyssynchrony and post-systolic shortening in young bodybuilders using anabolic-androgenic steroids. Am J Physiol Heart Circ Physiol 2021; 321:H509-H517. [PMID: 34242095 DOI: 10.1152/ajpheart.00136.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left ventricular (LV) remodeling, characterized by increased LV hypertrophy and depressed systolic and diastolic function, is observed in strength-trained athletes who use anabolic-androgenic steroids (AAS). Previous studies suggested a pathological remodeling with an increase in cardiac fibrosis in these athletes, which could promote intraventricular dyssynchrony. In this context, this study evaluated LV dyssynchrony in strength-trained athletes using AAS, hypothesizing that the use of AAS would lead to an increase in post-systolic shortening. Forty-four male subjects (aged 20-40 yr) were divided into three age-matched groups: strength-trained athletes using (users, n = 14) or not (nonusers, n = 15) AAS and healthy sedentary men (controls, n = 15). After completing a survey, each participant was assessed with two-dimensional (2D)-strain echocardiography. LV dyssynchrony was quantified using the standard deviation (SD) of the time to peak for longitudinal strain of the 18 LV-segments (from the apical 4, 3, and 2 chambers views), the longitudinal strain delay index (LSDI), and the segmental post-systolic index (PSI). Users showed mean AAS dosages of 564 ± 288 mg[Formula: see text]wk-1 with a mean protocol duration of 12 ± 6 wk and a history of use of 4.7 ± 1.8 yr. They exhibited a greater LV mass index and depressed systolic and diastolic function when compared with both nonusers and controls. The decrease in LV strain in users was predominantly observed at the interventricular septum level (-16.9% ± 2.5% vs. -19.2% ± 1.8% and -19.0% ± 1.6% in users, nonusers, and controls, respectively, P < 0.01). Users showed higher SD than controls (43 ± 8 ms vs. 32 ± 5 ms, respectively, P < 0.01). The LSDI was significantly higher in users compared with both nonusers and controls (-23.4 ± 9.5 vs. -15.9 ± 9.3 and -9.8 ± 3.9, respectively, P < 0.01). PSI, calculated on the basal inferoseptal, basal anteroseptal, and basal inferolateral segments, were also greater in users compared with the two other groups. Our results reported an increase in LV dyssynchrony in young AAS users that brought new evidences of a pathologic cardiac remodeling in this specific population.NEW & NOTEWORTHY Illicit androgenic anabolic steroids (AAS) use is widespread, but data on LV dyssynchrony are lacking, although it could be increased by a higher prevalence of myocardial fibrosis reported in this population. In AAS users, the decrease in LV strain was predominantly observed in interventricular segments. All dyssynchrony indices were higher in AAS users and several segments exhibited post-systolic shortening. These results showed an association between AAS consumption, LV remodeling, and dyssynchrony.
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Affiliation(s)
- Antoine Grandperrin
- Laboratoire de Phram-écologie Cardiovasculaire (LAPEC) EA4278, Avignon University, Avignon, France
| | - Iris Schuster
- PhyMedExp, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Montpellier University, Montpellier, France
| | - Thomas Rupp
- Inter-university Laboratory of Human Movement Science, University Savoie Mont Blanc, Chambéry, France
| | - Omar Izem
- Laboratoire de Phram-écologie Cardiovasculaire (LAPEC) EA4278, Avignon University, Avignon, France
| | - Philippe Obert
- Laboratoire de Phram-écologie Cardiovasculaire (LAPEC) EA4278, Avignon University, Avignon, France
| | - Stéphane Nottin
- Laboratoire de Phram-écologie Cardiovasculaire (LAPEC) EA4278, Avignon University, Avignon, France
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Riolet C, Menet A, Mailliet A, Binda C, Altes A, Appert L, Castel AL, Delelis F, Viart G, Guyomar Y, Le Goffic C, Decroocq M, Ennezat PV, Graux P, Tribouilloy C, Marechaux S. Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2021; 34:976-986. [PMID: 34157400 DOI: 10.1016/j.echo.2021.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The relationship between myocardial work assessment using pressure-strain loops by echocardiography before cardiac resynchronization therapy (CRT) and response to CRT has been recently revealed. Among myocardial work parameters, the impact of left ventricular myocardial global wasted work (GWW) on response to CRT and outcome following CRT has been seldom studied. Hence, the authors evaluated the relationship between preprocedural GWW and outcome in a large prospective cohort of patients with heart failure (HF) and reduced ejection fraction receiving CRT. METHODS The study included 249 patients with HF. Myocardial work indices including GWW were calculated using speckle-tracking strain two-dimensional echocardiography using pressure-strain loops. End points of the study were (1) response to CRT, defined as left ventricular reverse remodeling and/or absence of hospitalization for HF, and (2) all-cause death during follow-up. RESULTS Median follow-up duration was 48 months (interquartile range, 43-54 months). Median preoperative GWW was 281 mm Hg% (interquartile range, 184-388 mm Hg%). Preoperative GWW was associated with CRT response (area under the curve, 0.74; P < .0001), and a 200 mm Hg% threshold discriminated CRT nonresponders from responders with 85% specificity and 50% sensitivity, even after adjustment for known predictors of CRT response (adjusted odds ratio, 4.03; 95% CI, 1.91-8.68; P < .001). After adjustment for established predictors of outcome in patients with HF with reduced ejection fraction receiving CRT, GWW < 200 mm Hg% remained associated with a relative increased risk for all-cause death compared with GWW ≥ 200 mm Hg% (adjusted hazard ratio, 2.0; 95% CI, 1.1-3.9; P = .0245). Adding GWW to a baseline model including known predictors of outcome in CRT resulted in an improvement of this model (χ2 to improve 4.85, P = .028). The relationship between GWW and CRT response and outcome was stronger in terms of size effect and statistical significance than for other myocardial work indices. CONCLUSIONS Low preoperative GWW (<200 mm Hg%) is associated with absence of CRT response in CRT candidates and with a relative increased risk for all-cause death. GWW appears to be a promising parameter to improve selection for CRT of patients with HF with reduced ejection fraction.
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Affiliation(s)
- Clemence Riolet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Aymeric Menet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Amandine Mailliet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Camille Binda
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Alexandre Altes
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Ludovic Appert
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Anne Laure Castel
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - François Delelis
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Guillaume Viart
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Yves Guyomar
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Caroline Le Goffic
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Marie Decroocq
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | | | - Pierre Graux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Christophe Tribouilloy
- EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France; Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Sylvestre Marechaux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France; EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France.
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9
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Gallard A, Galli E, Hubert A, Bidaut A, Le Rolle V, Smiseth O, Voigt JU, Donal E, Hernández AI. Echocardiographic view and feature selection for the estimation of the response to CRT. PLoS One 2021; 16:e0252857. [PMID: 34111154 PMCID: PMC8191962 DOI: 10.1371/journal.pone.0252857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an implant-based therapy applied to patients with a specific heart failure (HF) profile. The identification of patients that may benefit from CRT is a challenging task and the application of current guidelines still induce a non-responder rate of about 30%. Several studies have shown that the assessment of left ventricular (LV) mechanics by speckle tracking echocardiography can provide useful information for CRT patient selection. A comprehensive evaluation of LV mechanics is normally performed using three different echocardioraphic views: 4, 3 or 2-chamber views. The aim of this study is to estimate the relative importance of strain-based features extracted from these three views, for the estimation of CRT response. Several features were extracted from the longitudinal strain curves of 130 patients and different methods of feature selection (out-of-bag random forest, wrapping and filtering) have been applied. Results show that more than 50% of the 20 most important features are calculated from the 4-chamber view. Although features from the 2- and 3-chamber views are less represented in the most important features, some of the former have been identified to provide complementary information. A thorough analysis and interpretation of the most informative features is also provided, as a first step towards the construction of a machine-learning chain for an improved selection of CRT candidates.
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Affiliation(s)
- Alban Gallard
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Arnaud Hubert
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Auriane Bidaut
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Virginie Le Rolle
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
| | - Otto Smiseth
- Center for Cardiological Innovation and Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI UMR 1099, Rennes, France
- * E-mail:
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10
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Laczay B, Patel D, Grimm R, Xu B. State-of-the-art narrative review: multimodality imaging in electrophysiology and cardiac device therapies. Cardiovasc Diagn Ther 2021; 11:881-895. [PMID: 34295711 PMCID: PMC8261739 DOI: 10.21037/cdt-20-724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/30/2020] [Indexed: 12/07/2022]
Abstract
Cardiac electrophysiology procedures have evolved to provide improvement in morbidity and mortality for many patients. Cardiac resynchronization therapy (CRT), implantable cardioverter/defibrillator (ICD) placement and lead extraction procedures are proven procedures, associated with significant reductions in patient morbidity and mortality as well as improved quality of life. The applications and optimization of these therapies are an evolving field. The optimal use and outcomes of cardiac electrophysiology procedures require a multidisciplinary approach to patient selection, device selection, and procedural planning. Cardiac imaging using echocardiography plays a key role in selection of patients for CRT therapy, for guidance of left ventricular (LV) lead placement, and for optimization of atrioventricular pacing delays in patients with CRT. Cardiac computed tomography (CT) is an important tool in assessment of lead perforation, as well as assessing risk of lead extraction and procedural planning. Cardiac magnetic resonance imaging (MRI) is an important adjunct to transthoracic echocardiography for patient selection and risk stratification for defibrillator therapy for multiple disease states including ischemic cardiomyopathy, hypertrophic cardiomyopathy, cardiac sarcoidosis, and arrhythmogenic right ventricular cardiomyopathy (ARVC). Cardiac positron emission tomography (PET) is a useful adjunct to the diagnosis of device infections as well as inflammatory conditions including cardiac sarcoidosis. Our review attempts to summarize the contemporary roles of multimodality imaging in CRT therapy, ICD therapy and lead extraction therapy.
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Affiliation(s)
- Balint Laczay
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Divyang Patel
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Richard Grimm
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bo Xu
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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11
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The non-invasive assessment of myocardial work by pressure-strain analysis: clinical applications. Heart Fail Rev 2021; 27:1261-1279. [PMID: 34041679 PMCID: PMC9197903 DOI: 10.1007/s10741-021-10119-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
Abstract
Pressure–volume (PV) analysis is the most comprehensive way to describe cardiac function, giving insights into cardiac mechanics and energetics. However, PV analysis still remains a highly invasive and time-consuming method, preventing it from integration into clinical practice. Most of the echocardiographic parameters currently used in the clinical routine to characterize left ventricular (LV) systolic function, such as LV ejection fraction and LV global longitudinal strain, do not take the pressure developed within the LV into account and therefore fall too short in describing LV function as a hydraulic pump. Recently, LV pressure-strain analysis has been introduced as a new technique to assess myocardial work in a non-invasive fashion. This new method showed new insights in comparison to invasive measurements and was validated in different cardiac pathologies, e.g., for the detection of coronary artery disease, cardiac resynchronization therapy (CRT)-response prediction, and different forms of heart failure. Non-invasively assessed myocardial work may play a major role in guiding therapies and estimating prognosis. However, its incremental prognostic validity in comparison to common echocardiographic parameters remains unclear. This review aims to provide an overview of pressure-strain analysis, including its current application in the clinical arena, as well as potential fields of exploitation.
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12
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Jiang W, Liu Y, He Z, Zhou Y, Wang C, Jiang Z, Zhou W. Prognostic value of left ventricular mechanical dyssynchrony in hypertrophic cardiomyopathy patients with low risk of sudden cardiac death. Nucl Med Commun 2021; 42:182-189. [PMID: 33252510 PMCID: PMC10961108 DOI: 10.1097/mnm.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSES This study aims to explore the prognostic value of left ventricular mechanical dyssynchrony (LVMD) in hypertrophic cardiomyopathy (HCM) patients with low risk of sudden cardiac death (SCD). METHODS This retrospective study was performed in 50 patients with HCM who underwent Tc-99m sestamibi GSPECT-MPI. All patients were at low risk of SCD, defined as HCM risk-SCD scores <6%. Phase SD (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. The primary endpoint was the composite major adverse cardiovascular events (MACE), including all-cause mortality, rehospitalization of heart failure symptoms, new-onset stroke, and new-onset syncope. Variables with significant difference between MACE group and non-MACE group were further assessed by Cox regression analysis. RESULTS During follow-up, MACE occurred in 20 patients. Systolic-PSD, systolic-PBW, diastolic-PSD, and diastolic-PBW were all significantly greater in the MACE group. Multivariate analysis revealed that history of syncope, history of atrial fibrillation, and all the four LVMD parameters were independent predictors of MACE. All LVMD parameters showed similar accuracy to predict MACE. Sequential models indicated that both systolic and diastolic LVMD parameters added incremental value beyond atrial fibrillation and syncope. CONCLUSION LVMD parameters are independent predictors of MACE, which add incremental prognostic information in patients with HCM risk-SCD scores <6%.
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Affiliation(s)
- Wanying Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
- Department of Cardiology, Jiangsu Province Hospital, Nanjing
| | - Yanyun Liu
- Department of Computer and Communication Engineering, Zhengzhou University of Light Industry, Zhengzhou, Henan, China
| | - Zhuo He
- Department of Applied Computing, Michigan Technological University, Houghton, Michigan, USA
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
- Department of Cardiology, Jiangsu Province Hospital, Nanjing
| | - Cheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
- Department of Cardiology, Jiangsu Province Hospital, Nanjing
| | - Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University
- Department of Cardiology, Jiangsu Province Hospital, Nanjing
| | - Weihua Zhou
- Department of Applied Computing, Michigan Technological University, Houghton, Michigan, USA
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Kar J, Cohen MV, McQuiston SA, Malozzi CM. Comprehensive enhanced methodology of an MRI-based automated left-ventricular chamber quantification algorithm and validation in chemotherapy-related cardiotoxicity. J Med Imaging (Bellingham) 2020; 7:064002. [PMID: 33241073 PMCID: PMC7667516 DOI: 10.1117/1.jmi.7.6.064002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/23/2020] [Indexed: 01/25/2025] Open
Abstract
Purpose: To comprehensively outline the methodology of a fully automated, MRI motion-guided, left-ventricular (LV) chamber quantification algorithm that enhances a similar, existing semi-automated approach. Additionally, to validate the motion-guided technique in comparison to chamber quantification with a vendor tool in post-chemotherapy breast cancer patients susceptible to cardiotoxicity. Approach: LV deformation data were acquired with the displacement encoding with stimulated echoes (DENSE) sequence on N = 21 post-chemotherapy female patients and N = 21 age-matched healthy females. The new chamber quantification algorithm consists of detecting LV boundary motion via a combination of image quantization and DENSE phase-encoded displacements. LV contractility was analyzed via chamber quantification and computations of 3D strains and torsion. For validation, estimates of chamber quantification with the motion-guided algorithm on DENSE and steady-state free precession (SSFP) acquisitions, and similar estimates with an existing vendor tool on DENSE acquisitions were compared via repeated measures analysis. Patient results were compared to healthy subjects for observing abnormalities. Results: Repeated measures analysis showed similar LV ejection fractions (LVEF), 59 % ± 6 % , 58 % ± 6 % , and 58 % ± 6 % , p = 0.2 , by applying the motion-guided algorithm on DENSE and SSFP and vendor tool on DENSE acquisitions, respectively. Differences found between patients and healthy subjects included enlarged basal diameters ( 5.0 ± 0.5 cm versus 4.4 ± 0.5 cm , p < 0.01 ), torsions ( p < 0.001 ), and longitudinal strains ( p < 0.001 ), but not LVEF ( p = 0.1 ). Conclusions: Measurement similarities between new and existing tools, and between DENSE and SSFP validated the motion-guided algorithm and differences found between subpopulations demonstrate the ability to detect contractile abnormalities.
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Affiliation(s)
- Julia Kar
- University of South Alabama, Department of Mechanical Engineering, Mobile, Alabama, United States
- University of South Alabama, Department of Pharmacology, Mobile, Alabama, United States
| | - Michael V. Cohen
- University of South Alabama, Department of Cardiology, Mobile, Alabama, United States
| | - Samuel A. McQuiston
- University of South Alabama, Department of Radiology, Mobile, Alabama, United States
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Kozlovskaya V, Liu F, Yang Y, Ingle K, Qian S, Halade GV, Urban VS, Kharlampieva E. Temperature-Responsive Polymersomes of Poly(3-methyl- N-vinylcaprolactam)- block-poly( N-vinylpyrrolidone) To Decrease Doxorubicin-Induced Cardiotoxicity. Biomacromolecules 2019; 20:3989-4000. [PMID: 31503464 DOI: 10.1021/acs.biomac.9b01026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Despite being one of the most potent chemotherapeutics, doxorubicin (DOX) facilitates cardiac toxicity by irreversibly damaging the cardiac muscle as well as severely dysregulating the immune system and impairing the resolution of cardiac inflammation. Herein, we report synthesis and aqueous self-assembly of nanosized polymersomes from temperature-responsive poly(3-methyl-N-vinylcaprolactam)-block-poly(N-vinylpyrrolidone) (PMVC-PVPON) diblock copolymers and demonstrate their potential to minimize DOX cardiotoxicity compared to liposomal DOX. RAFT polymerization of vinylpyrrolidone and 3-methyl-N-vinylcaprolactam, which are structurally similar monomers but have drastically different hydrophobicity, allows decreasing the cloud point of PMVCm-PVPONn copolymers below 20 °C. The lower critical solution temperature (LCST) of the PMVC58-PVPONn copolymer varied from 19.2 to 18.6 and to 15.2 °C by decreasing the length of the hydrophilic PVPONn block from n = 98 to n = 65 and to n = 20, respectively. The copolymers assembled into stable vesicles at room temperature when PVPON polymerization degrees were 65 and 98. Anticancer drug DOX was entrapped with high efficiency into the aqueous PMVC58-PVPON65 polymersomal core surrounded by the hydrophobic temperature-sensitive PMVC shell and the hydrophilic PVPON corona. Unlike many liposomal, micellar, or synthetic drug delivery systems, these polymersomes exhibit an exceptionally high loading capacity of DOX (49%) and encapsulation efficiency (95%) due to spontaneous loading of the drug at room temperature from aqueous DOX solution. We also show that C57BL/6J mice injected with the lethal dose of DOX at 15 mg kg-1 did not survive the 14 day treatment, resulting in 100% mortality. The DOX-loaded PMVC58-PVPON65 polymersomes did not cause any mortality in mice indicating that they can be used for successful DOX encapsulation. The gravimetric analyses of the animal organs from mice treated with liposome-encapsulated DOX (Lipo-DOX) and PMVC58-PVPON65 polymersomes (Poly-DOX) revealed that the Lipo-DOX injection caused some toxicity manifesting as decreased body weight compared to Poly-DOX and saline control. Masses of the left ventricle of the heart, lung, and spleen reduced in the Lipo-DOX-treated mice compared to the nontoxic saline control, while no significant decrease of those masses was observed for the Poly-DOX-treated mice. Our results provide evidence for superior stability of synthetic polymersomes in vivo and show promise for the development of next-generation drug carriers with minimal side effects.
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Affiliation(s)
| | | | | | | | - Shuo Qian
- Neutron Scattering Division, Neutron Sciences Directorate , Oak Ridge National Laboratory , Oak Ridge , Tennessee 37831 , United States
| | | | - Volker S Urban
- Neutron Scattering Division, Neutron Sciences Directorate , Oak Ridge National Laboratory , Oak Ridge , Tennessee 37831 , United States
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15
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Zhu M, Chen H, Fulati Z, Liu Y, Su Y, Shu X. The value of left ventricular strain-volume loops in predicting response to cardiac resynchronization therapy. Cardiovasc Ultrasound 2019; 17:3. [PMID: 30777069 PMCID: PMC6379938 DOI: 10.1186/s12947-019-0153-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) speckle tracking imaging (STI) allows the simultaneous assessment of left ventricular (LV) strain and volume. We aim to explore the value of LV strain-volume loops in predicting response to cardiac resynchronization therapy (CRT). METHODS Forty heart failure (HF) patients scheduled for CRT and twenty healthy individuals were enrolled. All subjects received a 3D echocardiography and 3D STI analysis to acquire LV global and segmental principal strain (PS) and volume simultaneously. Values were plotted in a Cartesian system to construct PS-volume loop which was assessed using the two characteristics of the linear fitting curve: the slope and the coefficient of determination (R2-S/D coupling). RESULTS HF patients at baseline showed significantly lower slope and R2-S/D coupling of all PS-volume loops than healthy subjects. As for as comparing Segmental PS-Global volume loop at baseline, Midseptal R2-S/D coupling was lower and Midlateral slope was higher in CRT responders than in non-responders. For each individual, the abnormal segmental heterogeneity of Midseptal slope and R2-S/D coupling were lower than Midlateral was observed only in responders. At follow-up, significant improvements of the Midseptal slope and R2-S/D coupling were observed in responders. Midseptal R2-S/D coupling at baseline was an independent predictor of CRT response and the cut-off value of 0.55 was recommended with sensitivity of 89% and specificity of 77%. CONCLUSIONS Analysis of strain-volume loops could provide unique information for predicting response to CRT. Assessment of septal myocardial wasted work at baseline is helpful to improve patient selection for CRT.
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Affiliation(s)
- Mengruo Zhu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China.,Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Zibire Fulati
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Yang Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China. .,Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China.
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16
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Arvidsson PM, Töger J, Pedrizzetti G, Heiberg E, Borgquist R, Carlsson M, Arheden H. Hemodynamic forces using four-dimensional flow MRI: an independent biomarker of cardiac function in heart failure with left ventricular dyssynchrony? Am J Physiol Heart Circ Physiol 2018; 315:H1627-H1639. [DOI: 10.1152/ajpheart.00112.2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patients with heart failure with left ventricular (LV) dyssynchrony often do not respond to cardiac resynchronization therapy (CRT), indicating that the pathophysiology is insufficiently understood. Intracardiac hemodynamic forces computed from four-dimensional (4-D) flow MRI have been proposed as a new measure of cardiac function. We therefore aimed to investigate how hemodynamic forces are altered in LV dyssynchrony. Thirty-one patients with heart failure and LV dyssynchrony and 39 control subjects underwent cardiac MRI with the acquisition of 4-D flow. Hemodynamic forces were computed using Navier-Stokes equations and integrated over the manually delineated LV volume. The ratio between transverse (lateral-septal and inferior-anterior) and longitudinal (apical-basal) forces was calculated for systole and diastole separately and compared with QRS duration, aortic valve opening delay, global longitudinal strain, and ejection fraction (EF). Patients exhibited hemodynamic force patterns that were significantly altered compared with control subjects, including loss of longitudinal forces in diastole (force ratio, control subjects vs. patients: 0.32 vs. 0.90, P < 0.0001) and increased transverse force magnitudes. The systolic force ratio was correlated with global longitudinal strain and EF ( P < 0.01). The diastolic force ratio separated patients from control subjects (area under the curve: 0.98, P < 0.0001) but was not correlated to other dyssynchrony measures ( P > 0.05 for all). Hemodynamic forces by 4-D flow represent a new approach to the quantification of LV dyssynchrony. Diastolic force patterns separate healthy from diseased ventricles. Different force patterns in patients indicate the possible use of force analysis for risk stratification and CRT implantation guidance. NEW & NOTEWORTHY In this report, we demonstrate that patients with heart failure with left ventricular dyssynchrony exhibit significantly altered hemodynamic forces compared with normal. Force patterns in patients mechanistically reflect left ventricular dysfunction on the organ level, largely independent of traditional dyssynchrony measures. Force analysis may help clinical decision making and could potentially be used to improve therapy outcomes.
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Affiliation(s)
- Per M. Arvidsson
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Johannes Töger
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Einar Heiberg
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Faculty of Engineering, Lund, Sweden
| | - Rasmus Borgquist
- Lund University, Department of Cardiology, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Håkan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
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17
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Fulati Z, Liu Y, Sun N, Kang Y, Su Y, Chen H, Shu X. Speckle tracking echocardiography analyses of myocardial contraction efficiency predict response for cardiac resynchronization therapy. Cardiovasc Ultrasound 2018; 16:30. [PMID: 30453975 PMCID: PMC6245808 DOI: 10.1186/s12947-018-0148-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with left ventricular (LV) dysssynchrony, contraction that doesn't fall into ejection period (LVEj) results in a waste of energy due to inappropriate contraction timing, which was now widely treated by cardiac resynchronization therapy(CRT). Myocardial Contraction Efficiency was defined as the ratio of Efficient Contraction Time (ECTR) and amplitude of efficient contraction (ECR) during LVEj against that in the entire cardiac cycle. This study prospectively investigated whether efficiency indexes could predict CRT outcome. METHODS Our prospective pilot study including 70 CRT candidates, parameters of myocardial contraction timing and contractility were measured by speckle tracking echocardiography (STE) and efficiency indexes were calculated accordingly at baseline and at 6-month follow-up. Primary outcome events were predefined as death or HF hospitalization, and secondary outcome events were defined as all-cause death during the follow-up. 16-segement Standard deviation of time to onset strain (TTO-16SD) and time to peak strain (TTP-16SD) were included as the dyssynchrony indexes. RESULTS According to LV end systolic volume (LVESV) and LV eject fraction(LVEF) values at 6-month follow-up, subjects were classified into responder and non-responder groups, ECR (OR 0.87, 95%CI 0.78-0.97, P < 0.05) and maximum longitudinal strain (MLS) (OR 2.22, 95%CI 1.36-3.61, P < 0.01) were the two independent predictors for CRT response, Both TTO-16SD and TTP-16SD failed to predict outcome. Patients with poorer myocardial contraction efficiency and better contractility are more likely to benefit from CRT. CONCLUSIONS STE can evaluate left ventricular contraction efficiency and contractility to predict CRT response. When analyzing myocardial strain by STE, contraction during LVEj should be highlighted.
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Affiliation(s)
- Zibire Fulati
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yang Liu
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ning Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yu Kang
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yangang Su
- Department of Cardiology; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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18
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Maufrais C, Rupp T, Bouzat P, Doucende G, Verges S, Nottin S, Walther G. Heart mechanics at high altitude: 6 days on the top of Europe. Eur Heart J Cardiovasc Imaging 2018; 18:1369-1377. [PMID: 28329216 DOI: 10.1093/ehjci/jew286] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/10/2016] [Indexed: 12/23/2022] Open
Abstract
Aims The aim of this study was to analyse the underlying mechanisms of left and right ventricular (LV and RV) functional alterations during several days in high-altitude hypoxia. Methods and results Resting evaluations of LV and RV function and mechanics were assessed by Speckle Tracking Echocardiography on 11 subjects at sea level (SLPRE), 3 ± 2 h after helicopter transport to high altitude (D0), at day 2 (D2), day 4 (D4) and day 6 (D6) at 4350 m and 5 ± 2 h after return to sea level (SLPOST). Subjects experienced acute mountain sickness (AMS) during the first days at 4350 m. LV systolic function, RV systolic and diastolic function, LV and RV strains and LV synchrony were unchanged at high altitude. Peak twist was increased at D0, continued to increase until D6 (SLPRE: 9.0 ± 5.1deg; D6: 13.0 ± 4.0deg, P < 0.05), but was normalized at SLPOST. Early filling decreased at high altitude with a nadir at D2 (SLPRE: 78 ± 13 cm s-1; D2: 66 ± 11 cm s-1, P < 0.05). LV filling pressures index was decreased at high altitude with the minimum value obtained at D2 and remained reduced at SLPOST. Untwisting, an important factor of LV filling, was not decreased but was delayed at 4350 m. Conclusions High-altitude exposure impaired LV diastolic function with the greatest effect observed at D2, concomitantly with the occurrence of AMS. The LV early filling impairments resulted from an increased RV afterload, a decrease in LV filling pressure and a delayed LV untwist. However, the increased LV twist probably acted as a compensatory mechanism to maintain cardiac performance during high-altitude hypoxia.
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Affiliation(s)
- Claire Maufrais
- U1042, INSERM, Domaine de la Merci, F-38700, La Tronche - Grenoble, France.,Laboratoire HP2, Grenoble Alpes Université, Avenue Kimberley, F-38434, Echirolles - Grenoble, France
| | - Thomas Rupp
- U1042, INSERM, Domaine de la Merci, F-38700, La Tronche - Grenoble, France.,Laboratoire HP2, Grenoble Alpes Université, Avenue Kimberley, F-38434, Echirolles - Grenoble, France.,Laboratoire Interuniversitaire de Biologie de la Motricité, Université Savoie Mont Blanc, 27 rue Marcoz F-73000, Chambéry, France
| | - Pierre Bouzat
- Grenoble Institute of Neurosciences, INSERM U1216, Chemin Fortuné Ferrini, F-38700 La Tronche - Grenoble, France.,Pôle Anesthésie Réanimation, CHU de Grenoble, Avenue Maquis du Grésivaudan, F-38700 La Tronche - Grenoble, France
| | - Gregory Doucende
- Laboratoire Performance et Santé en Altitude, Université de Perpignan, 7 Avenue Pierre de Coubertin, F-66120, Font-Romeu, France
| | - Samuel Verges
- U1042, INSERM, Domaine de la Merci, F-38700, La Tronche - Grenoble, France.,Laboratoire HP2, Grenoble Alpes Université, Avenue Kimberley, F-38434, Echirolles - Grenoble, France
| | - Stéphane Nottin
- Avignon University, LAPEC EA4278, 74 Rue Louis Pasteur, F-84000, Avignon, France
| | - Guillaume Walther
- Avignon University, LAPEC EA4278, 74 Rue Louis Pasteur, F-84000, Avignon, France
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19
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Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
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20
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Galli E, Leclercq C, Fournet M, Hubert A, Bernard A, Smiseth OA, Mabo P, Samset E, Hernandez A, Donal E. Value of Myocardial Work Estimation in the Prediction of Response to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2018; 31:220-230. [DOI: 10.1016/j.echo.2017.10.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Indexed: 10/18/2022]
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21
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Höke U, Bax JJ, Ajmone Marsan N, Delgado V. Echocardiography in Cardiac Resynchronization Therapy. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Abstract
Some form of the assessment of observer variability may be the most frequent statistical task in medical literature. Still, very little attempt is made to make the reported methods uniform and clear to the reader. This paper provides overview of various measures of observer variability, and a rationale of why using standard error of measurement (SEM) is preferable to other measures of observer variability. The supplemental file contains examples on how to design a proper repeatability and reproducibility assessment, determine appropriate sample size, and test for significance of its findings.
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Affiliation(s)
- Zoran B Popović
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - James D Thomas
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
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23
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Ternacle J, Bremont C, d’Humieres T, Faivre L, Doan HL, Gallet R, Oliver L, Dubois-Randé JL, Lim P. Left ventricular dyssynchrony and 2D and 3D global longitudinal strain for differentiating physiological and pathological left ventricular hypertrophy. Arch Cardiovasc Dis 2017; 110:403-412. [DOI: 10.1016/j.acvd.2016.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/28/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
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24
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den Boer SL, du Marchie Sarvaas GJ, Klitsie LM, van Iperen GG, Tanke RB, Helbing WA, Backx AP, Rammeloo LA, Dalinghaus M, ten Harkel AD. Distribution of strain patterns in children with dilated cardiomyopathy. Echocardiography 2017; 34:881-887. [DOI: 10.1111/echo.13548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Susanna L. den Boer
- Departments of Pediatrics; Division of Pediatric Cardiology; Sophia Children's Hospital; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Gideon J. du Marchie Sarvaas
- Departments of Pediatrics; Division of Pediatric Cardiology; Beatrix Children's Hospital; University Medical Center Groningen; Groningen The Netherlands
| | - Liselotte M. Klitsie
- Departments of Pediatrics; Division of Pediatric Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Gabriëlle G. van Iperen
- Departments of Pediatrics; Division of Pediatric Cardiology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - Ronald B. Tanke
- Departments of Pediatrics; Division of Pediatric Cardiology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Willem A. Helbing
- Departments of Pediatrics; Division of Pediatric Cardiology; Sophia Children's Hospital; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Ad P.C.M. Backx
- Departments of Pediatrics; Division of Pediatric Cardiology; Emma Children's Hospital; Academic Medical Center; Amsterdam The Netherlands
| | - Lukas A.J. Rammeloo
- Departments of Pediatrics; Division of Pediatric Cardiology; Free University Medical Center; Amsterdam The Netherlands
| | - Michiel Dalinghaus
- Departments of Pediatrics; Division of Pediatric Cardiology; Sophia Children's Hospital; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Arend D.J. ten Harkel
- Departments of Pediatrics; Division of Pediatric Cardiology; Leiden University Medical Center; Leiden The Netherlands
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25
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Surkova E, Badano LP, Bellu R, Aruta P, Sambugaro F, Romeo G, Migliore F, Muraru D. Left bundle branch block: from cardiac mechanics to clinical and diagnostic challenges. Europace 2017; 19:1251-1271. [DOI: 10.1093/europace/eux061] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
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26
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Gendre R, Lairez O, Mondoly P, Duparc A, Carrié D, Galinier M, Berry I, Cognet T. Research of predictive factors for cardiac resynchronization therapy: a prospective study comparing data from phase-analysis of gated myocardial perfusion single-photon computed tomography and echocardiography. Ann Nucl Med 2017; 31:218-226. [DOI: 10.1007/s12149-017-1148-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
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27
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Abstract
Non-Doppler, 2-dimensional strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements, which serves as a major advancement in understanding myocardial deformation. It analyzes motion in ultrasound imaging by tracking speckles in 2 dimensions. There are a lot of data emerging with multiple applications of strain imaging in the clinical practice of echocardiography. As incorporation of strain imaging in daily practice has been challenging, we intend to systematically highlight the top 10 applications of speckle-tracking echocardiography, which every cardiologist should be aware of: chemotherapy cardiotoxicity, left ventricular assessment, cardiac amyloidosis, hypertrophic obstructive cardiomyopathy, right ventricular dysfunction, valvular heart diseases (aortic stenosis and mitral regurgitation), cardiac sarcoidosis, athlete heart, left atrial assessment, and cardiac dyssynchrony.
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28
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Marek J, Gandalovičová J, Kejřová E, Pšenička M, Linhart A, Paleček T. Echocardiography and cardiac resynchronization therapy. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Rosa I, Marini C, Stella S, Ancona F, Spartera M, Margonato A, Agricola E. Mechanical dyssynchrony and deformation imaging in patients with functional mitral regurgitation. World J Cardiol 2016; 8:146-162. [PMID: 26981211 PMCID: PMC4766266 DOI: 10.4330/wjc.v8.i2.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/06/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic functional mitral regurgitation (FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy (DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle (LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy (CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.
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30
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Vecera J, Penicka M, Eriksen M, Russell K, Bartunek J, Vanderheyden M, Smiseth OA. Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2016; 17:624-32. [PMID: 26921169 PMCID: PMC4871236 DOI: 10.1093/ehjci/jew019] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/13/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) in heart failure is limited by many non-responders. This study explores whether degree of wasted left ventricular (LV) work identifies CRT responders. Methods and results Twenty-one patients who received CRT according to guidelines were studied before and after 8 ± 3 months. By definition, segments that shorten in systole perform positive work, whereas segments that lengthen do negative work. Work was calculated from non-invasive LV pressure and strain by speckle tracking echocardiography. For each myocardial segment and for the entire LV, wasted work was calculated as negative work in percentage of positive work. LV wall motion score index (WMSI) was assessed by echocardiography. Response to CRT was defined as ≥15% reduction in end-systolic volume (ESV). Responder rate to CRT was 71%. In responders, wasted work for septum was 117 ± 102%, indicating more negative than positive work, and decreased to 14 ± 12% with CRT (P < 0.01). In the LV free wall, wasted work was 19 ± 16% and showed no significant change. Global LV wasted work decreased from 39 ± 21 to 17 ± 7% with CRT (P < 0.01). In non-responders, there were no significant changes. In multiple linear regression analysis, septal wasted work and WMSI were the only significant predictors of ESV reduction (β = 0.14, P = 0.01; β = 1.25, P = 0.03). Septal wasted work together with WMSI showed an area under the curve of 0.86 (95% confidence interval 0.71–1.0) for CRT response prediction. Conclusion Wasted work in the septum together with WMSI was a strong predictor of response to CRT. This novel principle should be studied in future larger studies.
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Affiliation(s)
- J Vecera
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation, Center for Heart Failure Research and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital and University of Oslo, Rikshospitalet, N-0027 Oslo, Norway Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - M Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - M Eriksen
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation, Center for Heart Failure Research and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital and University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
| | - K Russell
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation, Center for Heart Failure Research and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital and University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
| | - J Bartunek
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - O A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation, Center for Heart Failure Research and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital and University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
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31
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Ghani A, Delnoy PPHM, Ottervanger JP, Ramdat Misier AR, Smit JJJ, Adiyaman A, Elvan A. Association of apical rocking with long-term major adverse cardiac events in patients undergoing cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2016; 17:146-53. [PMID: 26453544 PMCID: PMC4882884 DOI: 10.1093/ehjci/jev236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/31/2015] [Indexed: 01/14/2023] Open
Abstract
AIMS Correctly identifying patients who will benefit from cardiac resynchronization therapy (CRT) is still challenging. 'Apical rocking' is observed in asynchronously contracting ventricles and is associated with echocardiographic response to CRT. The association of apical rocking and long-term clinical outcome is however unknown at present. We assessed the predictive value of left ventricular (LV) apical rocking on a long-term clinical outcome in patients treated with CRT. METHODS AND RESULTS Consecutive heart failure patients treated with primary indication for CRT-D between 2005 and 2009 were included in a prospective registry. Echocardiography was performed prior to CRT to assess apical rocking, defined as motion of the LV apical myocardium perpendicular to the LV long axis. Major adverse cardiac event (MACE) was defined as combined end point of cardiac death and/or heart failure hospitalization and/or appropriate therapy (ATP and/or ICD shocks). All echocardiograms were assessed by independent cardiologists, blinded for clinical data. Multivariable analyses were performed to adjust for potential confounders. Two hundred and ninety-five patients with echocardiography prior to implantation were included in the final analyses. Apical rocking was present in 45% of the study patients. Apical rocking was significantly more common in younger patients, females, patients with sinus rhythm, non-ischaemic cardiomyopathy, and in patients with LBBB and wider QRS duration. During a mean clinical follow-up of 5.2 ± 1.6 years, 92 (31%) patients reached the end point of the study (MACE). Patients with MACE had shorter QRS duration, had more ischaemic cardiomyopathy, and were more often on Amiodarone. In univariate analyses, MACE was associated with shorter QRS duration, ischaemic aetiology, and the absence of apical rocking. After multivariable analyses, apical rocking was associated with less MACE (hazards ratio, HR 0.44, 95% confidence interval, CI 0.25-0.77). CONCLUSION Apical rocking is an independent predictor of a favourable long-term outcome in CRT-D patients.
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Affiliation(s)
- Abdul Ghani
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Peter Paul H M Delnoy
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Jan Paul Ottervanger
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Anand R Ramdat Misier
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
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Is speckle tracking actually helpful for cardiac resynchronization therapy? J Echocardiogr 2016; 14:53-60. [PMID: 26767529 DOI: 10.1007/s12574-016-0275-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/09/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
What is the specific role of echocardiography in cardiac resynchronization therapy (CRT)? CRT has proven to be highly effective for improving symptoms and survival of patients with advanced heart failure (HF) and wide QRS. However, a significant minority of patients do not respond favorably to CRT on the basis of standard clinical selection criteria, including the electrocardiographic QRS width. Subsequently, echocardiographic assessment of left ventricular (LV) dyssynchrony has been considered useful for CRT for selected responders, but findings by multicenter studies suggest that its predictive value was not sufficiently robust to replace routine selection criteria for CRT. A more recent approach, however, using speckle-tracking echocardiography yields more accurate quantification of regional wall contraction. Speckle-tracking approaches have therefore generated a great deal of interest about their clinical applications for CRT. Although reports on speckle tracking have not been included in any recommendations as to whether patients should undergo CRT based on the current guidelines, speckle tracking can play an important supplementary part in CRT on the basis of a case-by-case clinical decision for challenging cases. Here, we review the strengths of speckle-tracking methods, and their current potential for clinical use in CRT.
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Malik V, Subramaniam A, Kapoor PM. Strain and strain rate: An emerging technology in the perioperative period. Ann Card Anaesth 2016; 19:112-21. [PMID: 26750682 PMCID: PMC4900405 DOI: 10.4103/0971-9784.173026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Newer noninvasive parameters are being used for perioperative detection of myocardial ischaemia. TDI and global strain rate are some of these parameters. TDI signal is a modification of the routine Doppler flow signal. It is obtained by using thresholding and filtering algorithms that reject echoes originating from the blood pool (by-passing the high pass filter). Set-Up of the machine by activating the TDI function allows decreasing the system gain using a low pass filter and eliminates the signal produced by blood flow. Doppler shift obtained from myocardial tissue motion are of higher amplitudes (reflectivity 40 dB higher) and move about 10 times slower than blood (velocity range: 0.06 to 0.24 m/s). Speckle tracking echocardiography (tissue tracking, 2D strain) utilizes routine gray-scale 2D echo images to calculate myocardial strain. Interactions of ultrasound with myocardium result in reflection and scattering. These interactions generate a finely gray-shaded, speckled pattern (acoustic marker). This speckled pattern is unique for each myocardial region and relatively stable throughout the cardiac cycle. Spatial and temporal image processing of acoustic speckles in both 2D and 3D allows for the calculation of myocardial velocity, strain, and Strain rate.
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Lumens J, Tayal B, Walmsley J, Delgado-Montero A, Huntjens PR, Schwartzman D, Althouse AD, Delhaas T, Prinzen FW, Gorcsan J. Differentiating Electromechanical From Non-Electrical Substrates of Mechanical Discoordination to Identify Responders to Cardiac Resynchronization Therapy. Circ Cardiovasc Imaging 2015; 8:e003744. [PMID: 26338877 DOI: 10.1161/circimaging.115.003744] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular (LV) mechanical discoordination, often referred to as dyssynchrony, is often observed in patients with heart failure regardless of QRS duration. We hypothesized that different myocardial substrates for LV mechanical discoordination exist from (1) electromechanical activation delay, (2) regional differences in contractility, or (3) regional scar and that we could differentiate electromechanical substrates responsive to cardiac resynchronization therapy (CRT) from unresponsive non-electrical substrates. METHODS AND RESULTS First, we used computer simulations to characterize mechanical discoordination patterns arising from electromechanical and non-electrical substrates and accordingly devise the novel systolic stretch index (SSI), as the sum of posterolateral systolic prestretch and septal systolic rebound stretch. Second, 191 patients with heart failure (QRS duration ≥120 ms; LV ejection fraction ≤35%) had baseline SSI quantified by automated echocardiographic radial strain analysis. Patients with SSI≥9.7% had significantly less heart failure hospitalizations or deaths 2 years after CRT (hazard ratio, 0.32; 95% confidence interval, 0.19-0.53; P<0.001) and less deaths, transplants, or LV assist devices (hazard ratio, 0.28; 95% confidence interval, 0.15-0.55; P<0.001). Furthermore, in a subgroup of 113 patients with intermediate electrocardiographic criteria (QRS duration of 120-149 ms or non-left bundle branch block), SSI≥9.7% was independently associated with significantly less heart failure hospitalizations or deaths (hazard ratio, 0.41; 95% confidence interval, 0.23-0.79; P=0.004) and less deaths, transplants, or LV assist devices (hazard ratio, 0.27; 95% confidence interval, 0.12-0.60; P=0.001). CONCLUSIONS Computer simulations differentiated patterns of LV mechanical discoordination caused by electromechanical substrates responsive to CRT from those related to regional hypocontractility or scar unresponsive to CRT. The novel SSI identified patients who benefited more favorably from CRT, including those with intermediate electrocardiographic criteria, where CRT response is less certain by ECG alone.
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Affiliation(s)
- Joost Lumens
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.).
| | - Bhupendar Tayal
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - John Walmsley
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Antonia Delgado-Montero
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Peter R Huntjens
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - David Schwartzman
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Andrew D Althouse
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Tammo Delhaas
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - Frits W Prinzen
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
| | - John Gorcsan
- From the CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands (J.L., J.W., P.R.H., T.D., F.W.P.); L'Institut de Rythmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France (J.L., P.R.H.); and Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (B.T., A.D.-M., D.S., A.D.A., J.G.)
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Pokharel P, Fujikura K, Bella JN. Clinical applications and prognostic implications of strain and strain rate imaging. Expert Rev Cardiovasc Ther 2015; 13:853-66. [DOI: 10.1586/14779072.2015.1056163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ghani A, Delnoy PPH, Adiyaman A, Ottervanger JP, Ramdat Misier AR, Smit JJJ, Elvan A. Septal rebound stretch as predictor of echocardiographic response to cardiac resynchronization therapy. IJC HEART & VASCULATURE 2015; 7:22-27. [PMID: 28785641 PMCID: PMC5497250 DOI: 10.1016/j.ijcha.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/01/2015] [Indexed: 01/14/2023]
Abstract
AIM Septal rebound stretch (SRSsept) reflects an inefficient deformation of the septum during systole and is a potential new echocardiographic tool to predict response to Cardiac Resynchronization Therapy (CRT). However, there are only limited data on the potential predictive value of SRSsept on echocardiographic response. We evaluated the predictive value of SRSsept on echocardiographic response to CRT in a large population. METHODS AND RESULTS A total of 138 consecutive patients with functional class II-IV heart failure who underwent CRT were studied. Echocardiography was performed at baseline and after a mean follow-up period of 22 ± 8 months. Echocardiographic response to CRT was defined as a reduction in LV end-systolic volume ≥ 15%. Receiver operating characteristic curve analysis was performed to define the optimal cut-off value for SRSsept. Multivariable analyses were performed to adjust for potential confounders. Mean age was 68 ± 8 years (30% female). Mean baseline LV ejection fraction was 26 ± 7%, 51% had ischemic etiology. LBBB or LBBB like morphology was present in 95% of patients. Mean SRSsept was 4.4 ± 3.2%, 56% of patients had SRSsept ≥ 4%. Ninety six patients (70%) were echocardiographic responders. Baseline SRSsept was significantly higher in responders compared to non-responders (5.1 ± 3.2 vs 3.0 ± 2.7, P < 0.001). The optimal cut-off value for SRSsept to predict response to CRT was 4.0%. After both univariate (OR 3.74, 95% CI 1.72-8.10) and multivariate analyses (OR 3.71, 95% CI 1.49-9.2), baseline SRSsept > 4% independently predicted the response to CRT. CONCLUSIONS Baseline septal rebound stretch is independently associated with echocardiographic response to CRT.
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Key Words
- CABG, coronary artery bypass grafting
- CRT, cardiac resynchronization therapy
- Cardiac resynchronization therapy
- Heart failure
- IVMD, inter-ventricular mechanical delay
- LBBB, left bundle branch block
- LV-dyssynchrony
- LVEDD, left ventricular end-diastolic diameter
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESD, left ventricular end-systolic diameter
- LVESV, left ventricular end-systolic volume
- NYHA, New York Heart Association
- PCI, percutaneous coronary intervention
- RBBB, right bundle branch block
- Response
- SRSSept, septal rebound stretch
- Septal rebound stretch
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Affiliation(s)
| | | | | | | | | | | | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
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Zhao L, Lu J, Cui ZM, Pavri BB, Dai M, Qian DJ, Shen WG, Guo T, Wang RX. Changes in left ventricular synchrony and systolic function in dilated cardiomyopathy patients with fragmented QRS complexes. Europace 2015; 17:1712-9. [PMID: 25825459 DOI: 10.1093/europace/euu408] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/24/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS Fragmented QRS (f-QRS) complexes are associated with adverse cardiovascular events in patients with coronary heart disease; however, the effects on patients with dilated cardiomyopathy (DCM) remain elusive. This study is to investigate the changes of left ventricular (LV) synchrony and systolic function in DCM patients with f-QRS complexes. METHODS AND RESULTS Twenty DCM patients with f-QRS complexes and 29 DCM patients without f-QRS (n-QRS) complexes were enrolled. The LV segmental longitudinal, radial and circumferential time to peak strain and general longitudinal systolic strain, radial strain, circumferential strain were measured, respectively, by speckle tracking imaging. The LV segmental standard deviations and maximal differences were also calculated. The LV dyssynchrony was defined as the time in peak anteroseptal wall to posterior wall strain >130 ms or longitudinal strain delay index >25%. The mean QRS durations in f-QRS and n-QRS groups were not different (P = ns). The incidence of LV dyssynchrony was 15/20 (75%) vs. 5/29 (17%) in two groups (P < 0.01). Two patients died of sudden death in f-QRS group during 2 years follow-up; however, no death in n-QRS group (P < 0.05). Patients in f-QRS group showed worsening LV dyssynchrony in f-QRS group after 2 years follow-up (P < 0.05). Overall, LV function was comparable at baseline (P = ns), but had significantly worsened only in the f-QRS group (P < 0.05). CONCLUSION The f-QRS complex is significantly associated with LV dyssynchrony in DCM patients and can be used as a reliable index to evaluate ventricular synchrony and predict the prognosis in DCM patients with narrow QRS complexes.
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Affiliation(s)
- Ling Zhao
- Department of Cardiology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, PR China
| | - Juan Lu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, PR China
| | - Zhi-Min Cui
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, PR China
| | - Behzad B Pavri
- Division of Cardiovascular Diseases, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Min Dai
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, PR China
| | - Da-Jun Qian
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, PR China
| | - Wei-Gang Shen
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, PR China
| | - Tao Guo
- Department of Cardiology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, PR China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, PR China
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De S, Popović ZB, Verhaert D, Dresing T, Wilkoff B, Starling R, Tang WW, Thomas JD, Grimm RA. Comparison of left ventricular torsion and strain with biventricular pacing in patients with underlying right bundle branch block versus those with left bundle branch block. Am J Cardiol 2015; 115:918-23. [PMID: 25779616 DOI: 10.1016/j.amjcard.2015.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
The benefits of biventricular pacing in patients with cardiac resynchronization therapy (CRT) remain poorly understood in those with right bundle branch block (RBBB). The aim of this study was to examine the differences in several speckle tracking-derived parameters, including left ventricular torsion and longitudinal strain with CRT on and off for patients with underlying left bundle branch block (LBBB) and RBBB. Twelve patients with CRT and RBBB were compared with a similar group of patients with underlying LBBB who were sent for evaluation and atrioventricular optimization. Echocardiographic images were acquired with biventricular pacing on and off. The 2 groups had similar baseline characteristics, including age, the ejection fraction, and QRS duration. During intrinsic conduction (CRT off), patients with LBBB had lower torsion angles than those with RBBB (2.3 ± 1.0° in those with LBBB vs 6.3 ± 1.0° in those with RBBB, p = 0.03) but trended toward improvements in torsional parameters, including torsional angle and peak untwisting velocity with CRT on, whereas these parameters worsened in patients with RBBB. Compared with CRT off, analyses of septal and lateral strain curves showed significant improvements in septal strain during 100% and 200% of systole with CRT on in patients with LBBB, whereas biventricular pacing resulted in a trend toward worsening of septal strain in patients with RBBB. Negligible changes were noted in lateral strain values. In conclusion, CRT favorably improves regional mechanics in patients with LBBB primarily involving the ventricular septum, with a negligible positive impact on cardiac function in patients with underlying RBBB.
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Opdahl A, Helle-Valle T, Skulstad H, Smiseth OA. Strain, Strain Rate, Torsion, and Twist: Echocardiographic Evaluation. Curr Cardiol Rep 2015; 17:568. [DOI: 10.1007/s11886-015-0568-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ghani A, Delnoy PPHM, Ottervanger JP, Misier ARR, Smit JJJ, Adiyaman A, Elvan A. Apical rocking is predictive of response to cardiac resynchronization therapy. Int J Cardiovasc Imaging 2015; 31:717-25. [DOI: 10.1007/s10554-015-0607-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/28/2015] [Indexed: 01/14/2023]
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Maruo T, Seo Y, Yamada S, Arita T, Ishizu T, Shiga T, Dohi K, Toide H, Furugen A, Inoue K, Daimon M, Kawai H, Tsuruta H, Nishigami K, Yuda S, Ozawa T, Izumi C, Fumikura Y, Wada Y, Doi M, Okada M, Takenaka K, Aonuma K. The Speckle Tracking Imaging for the Assessment of Cardiac Resynchronization Therapy (START) Study. Circ J 2015; 79:613-22. [DOI: 10.1253/circj.cj-14-0842] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takeshi Maruo
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women’s Medical University
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Hiroyuki Toide
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Azusa Furugen
- Department of Cardiology, Tokyo Women’s Medical University
| | - Katsuji Inoue
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine
| | - Masao Daimon
- Department of Cardiology, Juntendo University School of Medicine
| | - Hiroya Kawai
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine
| | | | - Satoshi Yuda
- Department of Clinical Laboratory Medicine, Sapporo Medical University School of Medicine
| | - Tomoya Ozawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | | | - Yuko Fumikura
- Department of Cardiology, Tsukuba Medical Center Hospital
| | - Yasuaki Wada
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Mariko Doi
- Tsukuba Critical Path Research and Education Integrated Leading (CREIL) Center, University of Tsukuba
| | - Masafumi Okada
- Tsukuba Critical Path Research and Education Integrated Leading (CREIL) Center, University of Tsukuba
| | - Katsu Takenaka
- Department of Laboratory Medicine, The University of Tokyo Hospital
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Kydd AC, Khan FZ, Ring L, Pugh PJ, Virdee MS, Dutka DP. Development of a multiparametric score to predict left ventricular remodelling and prognosis after cardiac resynchronization therapy. Eur J Heart Fail 2014; 16:1206-13. [PMID: 25302484 DOI: 10.1002/ejhf.167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 11/08/2022] Open
Abstract
AIMS Optimal delivery of CRT requires appropriate patient selection and device implantation. Echocardiographic predictors of CRT response individually appear to enhance patient selection, but do not fully reflect the complex underlying myocardial dysfunction. We hypothesized that a multiparametric approach would offer greater predictive value and sought to derive a score incorporating baseline characteristics including: dyssynchrony, LV function, and LV lead position. METHODS AND RESULTS Data were analysed from 294 patients undergoing CRT between June 2008 and December 2012. All patients were in sinus rhythm with QRS >120 ms, NYHA class II-IV, and LVEF <35%. Detailed clinical assessment including echocardiography was completed at baseline and 6 months after CRT. Response was defined as a ≥15% reduction in LV end-systolic volume. Dyssynchrony (interventricular delay and radial strain delay), global longitudinal strain, and LV lead position were independent predictors of LV remodelling and were used to derive a predictive score which correlated with reduction in LV volume (r = - 0.5, P < 0.001) and was higher with QRS >150 ms and non-ischaemic aetiology. A cut-off score <0.6 offered the highest specificity and positive predictive value (100%) to determine non-response. A score >3.28 offered high specificity (specificity 86%, sensitivity 70%) to predict response. Survival proportion at longer term follow-up was low (21%) in the group with predictive score <0.6. CONCLUSION A multiparametric strategy, which defines anticipated probability of response to CRT, offers potential to predict non-responders with poor long-term survival following CRT. The value of this approach in avoiding unnecessary device implantation with potential for harm requires validation in large multicentre studies.
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Affiliation(s)
- Anna C Kydd
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Maffè S, Paffoni P, Dellavesa P, Perucca A, Kozel D, Paino AM, Cucchi L, Zenone F, Bergamasco L, Pardo NF, Signorotti F, Baduena L, Parravicini U. Role of echocardiographic dyssynchrony parameters in predicting response to cardiac resynchronization therapy. J Cardiovasc Med (Hagerstown) 2014; 16:725-35. [PMID: 25004003 DOI: 10.2459/jcm.0000000000000111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIMS In the present study, we compare different echocardiographic cardiac dyssynchrony parameters, both of intraventricular and interventricular dyssynchrony, in order to predict response to cardiac resynchronization therapy (CRT). METHODS AND RESULTS In a population of 77 heart failure patients scheduled for CRT, we measured the interventricular mechanical delay (IVMD) and we analyzed six different parameters of intraventricular dyssynchony: the tissue Doppler imaging (TDI) septum-lateral wall delay, the systolic dyssynchrony index; the three-dimensional SD of the time to reach minimum systolic volume for 16 left ventricular segments (3D-SDI); the speckle-tracking radial, circumferential and longitudinal dyssynchrony. At 6 months of follow-up, 61 (79%) patients were responders (≤15% in left ventricular end-systolic volume). On baseline analysis, 3D-SDI, radial strain, longitudinal strain and circumferential strain and IVMD were significantly higher in responder group (10.8 ± 3.9 vs. 7.6 ± 1.8% for 3D-SDI; P = 0.003; 212 ± 91 vs. 125 ± 36 ms for radial strain, P = 0.0003; 185 ± 83 vs. 134 ± 53 ms for longitudinal strain, P = 0.02; 190 ± 80 vs. 130 ± 54 ms for circumferential strain, P = 0.006; 45 ± 21 vs. 30 ± 20 ms for IVMD; P = 0.01). On univariate and multivariate analysis, only IVMD was significantly associated with a complete echocardiographic response to CRT. 3D-SDI and radial strain present the better values of sensitivity and specificity, overall if associated to an evaluation of IVMD (sensitivity 76%, specificity 88%, for 3D-SDI + IVMD; sensitivity 80% and specificity 85% for radial strain + IVMD). CONCLUSION The novel parameters, such as 3D-SDI and speckle-tracking (particularly radial strain), offer better diagnostic accuracy in identifying patients who are responders to CRT. The addition of the contemporary parameter of IVMD improves the diagnostic accuracy.
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Affiliation(s)
- Stefano Maffè
- aDivision of Cardiology, SS Trinità Borgomanero Hospital bElectrophysiology and Cardiostimulation Laboratory, Policlinico di Monza Group cMedical Direction, SS Trinità Borgomanero Hospital, Novara, Italy
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Mochizuki Y, Tanaka H, Tatsumi K, Matsumoto K, Imanishi J, Yoshida A, Yokoyama M, Kawai H, Hirata KI. Easy-to-use comprehensive speckle-tracking approach for cardiac resynchronization therapy. Circ J 2014; 78:2250-8. [PMID: 24998188 DOI: 10.1253/circj.cj-14-0114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Left ventricular (LV) dyssynchrony has emerged as an important mechanism contributing to the patient's response to cardiac resynchronization therapy (CRT), but other potential factors, especially LV myocardial viability, are also influential. METHODS AND RESULTS: We studied 132 patients undergoing CRT. LV dyssynchrony was determined by anteroseptal-to-posterior wall delay on the mid-LV short-axis view using 2-dimensional speckle-tracking radial strain (≥130 ms as significant). Global circumferential strain (GCS), considered as a parameter of LV intrinsic myocardial function, was also determined as the peak GCS from the same view. Long-term follow-up was tracked over 40 months. Kaplan-Meier analysis indicated that patients with GCS >3.9% experienced fewer cardiovascular events overall (log-rank P=0.034). Similarly, patients with GCS >3.9% and ≥6.6% experienced fewer cardiovascular events than those with GCS ≤3.9% and <6.6% among patients with and without LV dyssynchrony (log-rank P=0.025 and P=0.029, respectively). An important finding from multivariate Cox proportional hazards analysis was that LV dyssynchrony and GCS were independently associated with cardiovascular events. Of note, only 2±1 min per patient were needed to analyze both LV dyssynchrony and GCS from the same routine mid-LV short-axis view. CONCLUSIONS This easy-to-use combined assessment of LV dyssynchrony and myocardial function using speckle-tracking strain from the same mid-LV short-axis view may well have clinical implications for CRT.
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Affiliation(s)
- Yasuhide Mochizuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Predicting the response to cardiac resynchronization therapy using 99mTc-tetrofosmin myocardial scintigraphy in patients with drug-refractory heart failure: additional value of the washout of 99mTc-tetrofosmin. Nucl Med Commun 2014; 35:939-46. [PMID: 24977350 DOI: 10.1097/mnm.0000000000000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A lack of response to cardiac resynchronization therapy (CRT) has been reported in 20-40% of heart failure patients with left ventricular (LV) dyssynchrony who underwent treatment based on the established guidelines. The study aimed to investigate the relationship between (99m)Tc-tetrofosmin ((99m)Tc-TF) myocardial scintigraphy and the response to CRT. PATIENTS AND METHODS Twenty-one patients with drug-refractory heart failure who underwent CRT were evaluated. All patients underwent (99m)Tc-TF myocardial scintigraphy before and after CRT. Single-photon emission computed tomography images of (99m)Tc-TF were acquired at 30 min and 3 h after injection and were used to determine the total defect score (TDS) and washout score (WOS). The change in the LV volume and ejection fraction (ΔLVEF) and relative reduction in left ventricular end-systolic volume (%ΔLVESV) were calculated as an index of LV functional recovery after CRT. Response to CRT was considered to have occurred when ΔLVEF was greater than 15% or when ΔLVEF was greater than 5% and %ΔLVESV was greater than 15%. RESULTS Significant differences were observed between the patients who responded to CRT (the responder group, 13 patients) and the nonresponder group (eight patients) for both early and delayed TDS and WOS (P<0.05). Moreover, there was a good correlation between early TDS before CRT and both ΔLVEF and %ΔLVESV (P<0.01) and an excellent correlation between WOS before CRT and both ΔLVEF and %ΔLVESV (P<0.01). CONCLUSION Evaluating the washout of (99m)Tc-TF in addition to myocardial perfusion before CRT using (99m)Tc-TF myocardial scintigraphy might be useful in drug-refractory heart failure patients.
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Tatsumi K, Tanaka H, Matsumoto K, Miyoshi T, Hiraishi M, Tsuji T, Kaneko A, Ryo K, Fukuda Y, Norisada K, Onishi T, Yoshida A, Kawai H, Hirata KI. Combined Baseline Strain Dyssynchrony Index and Its Acute Reduction Predicts Mid-Term Left Ventricular Reverse Remodeling and Long-Term Outcome after Cardiac Resynchronization Therapy. Echocardiography 2014; 31:464-73. [DOI: 10.1111/echo.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kazuhiro Tatsumi
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tatsuya Miyoshi
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Mana Hiraishi
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Takayuki Tsuji
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Akihiro Kaneko
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Keiko Ryo
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Yuko Fukuda
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Kazuko Norisada
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tetsuari Onishi
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Akihiro Yoshida
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Hiroya Kawai
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
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Introduction to indexes for cardiac resynchronization therapy (CRT) indication. J Med Ultrason (2001) 2014; 41:261-74. [PMID: 27277786 DOI: 10.1007/s10396-013-0499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wang CL, Powell BD, Redfield MM, Miyazaki C, Fine NM, Olson LJ, Cha YM, Espinosa RE, Hayes DL, Hodge DO, Lin G, Friedman PA, Oh JK. Left ventricular discoordination index measured by speckle tracking strain rate imaging predicts reverse remodelling and survival after cardiac resynchronization therapy. Eur J Heart Fail 2014; 14:517-25. [DOI: 10.1093/eurjhf/hfs025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chun-Li Wang
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
- First Division of Cardiovascular Department; Chang Gung Memorial Hospital and College of Medicine, Chang Gung University; Taoyuan Taiwan
| | - Brian D. Powell
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | | | - Chinami Miyazaki
- Department of Cardiology; Higashisumiyoshi Morimoto Hospital; Osaka Japan
| | - Nowell M. Fine
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Lyle J. Olson
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Raul E. Espinosa
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - David L. Hayes
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - David O. Hodge
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Grace Lin
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Paul A. Friedman
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
| | - Jae K. Oh
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
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49
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Lim P, Donal E, Lafitte S, Derumeaux G, Habib G, Réant P, Thivolet S, Lellouche N, Grimm RA, Gueret P. Multicentre study using strain delay index for predicting response to cardiac resynchronization therapy (MUSIC study). Eur J Heart Fail 2014; 13:984-91. [DOI: 10.1093/eurjhf/hfr073] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pascal Lim
- Cardiovascular department; Henri Mondor University Hospital (APHP and INSERM U841); Créteil France
| | - Erwan Donal
- Pontchaillou University Hospital; Rennes France
| | | | | | | | | | | | - Nicolas Lellouche
- Cardiovascular department; Henri Mondor University Hospital (APHP and INSERM U841); Créteil France
| | | | - Pascal Gueret
- Cardiovascular department; Henri Mondor University Hospital (APHP and INSERM U841); Créteil France
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50
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Cai QZ, Liang Y, Zhu ZH, Lu XZ. Influence of percutaneous atrial septal defect closure on inter- and intra-ventricular mechanical dyssynchrony in adults: evaluation of strain pattern. Int J Cardiovasc Imaging 2014; 30:721-7. [PMID: 24504492 DOI: 10.1007/s10554-014-0385-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
Previous studies using speckle-tracking echocardiography (STE) for quantifying the functions of the right and left ventricles (RV and LV, respectively) in the presence of percutaneous atrial septal defect (ASD) closure have focused on the peak systolic strain (PSS). This study investigated changes in the mechanical dyssynchrony of ventricular contraction before and after ASD closure, issues that have been little addressed in the literature. Thirty-one adults with ASD were studied using two-dimensional STE before and 24 h after ASD closure. Thirty-one healthy age- and sex-matched subjects were recruited as controls. Global and segmental PSS values from the longitudinal, circumferential, and radial directions were analyzed. The time to peak systolic strain (PSST) and the standard deviation of the time to peak strain (SDT) among segments in each direction were calculated, to investigate the inter- and intra-ventricular mechanical dyssynchrony in these patients and improvements after closure. Compared to the control group, patients with ASD had higher RV free-wall longitudinal systolic strain, with increased PSST and SDT. The SDT values of the LV longitudinal and circumferential strains were also increased. By 24 h after ASD closure, the RV free-wall longitudinal strain and its PSST and SDT had reverted to normal levels. The LV circumferential strain was increased, and its SDT was decreased. The contraction period of the RV and myocardial contraction dyssynchrony in the RV and LV were increased in ASD patients. The inter- and intra-ventricular mechanical utilities were improved after percutaneous closure of the ASD.
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MESH Headings
- Adult
- Aged
- Cardiac Catheterization
- Case-Control Studies
- Echocardiography, Doppler
- Female
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/therapy
- Humans
- Male
- Middle Aged
- Myocardial Contraction
- Recovery of Function
- Time Factors
- Treatment Outcome
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Qi-Zhe Cai
- Department of Echocardiography, Cardiovascular Institute, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100037, China
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