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ABSTRACT: Cardiac resynchronization therapy (CRT) has emerged as a treatment option for patients with end-stage heart failure and a QRS duration ≥120 ms. Nonetheless, many patients with a prolonged QRS do not demonstrate left ventricular (LV) mechanical dyssynchrony, and discrepancies between electrical and mechanical dyssynchrony have been observed. In addition, several studies demonstrated that superior benefits after CRT could be achieved when the LV pacing lead was positioned at the most delayed myocardial segment.
A total of 248 heart failure patients scheduled for CRT were included. In all patients, a 12-lead electrocardiogram and 2-dimensional echocardiogram were obtained. Patients were divided into 5 QRS configuration subgroups: narrow, left bundle-branch block, right bundle-branch block, intraventricular conduction delay, and right ventricular pacing. With speckle-tracking radial strain analysis, we evaluated time to peak radial strain. Next, the segments with the least and with the most mechanical activation delay were identified, and LV dyssynchrony was defined as the time delay between the two.
Mean QRS duration was 164 ± 31 ms. Mean LV dyssynchrony in all patients was 186 ± 122 ms. Site of latest activation was predominantly located in the lateral (27%), posterior (26%), and inferior (20%) segments. Furthermore, extent of LV dyssynchrony was comparable between QRS configuration subgroups. An unequal distribution of LV segments with the most mechanical delay was observed in the left bundle-branch block and right ventricular pacing subgroups (P < .001 for both), whereas in the narrow, right bundle-branch block, and intraventricular conduction delay subgroups, a more homogeneous distribution was noted. No differences in distribution pattern or in extent of LV dyssynchrony were observed between ischemic and nonischemic heart failure patients.
The lateral, posterior, and inferior segments take up 73% of the total latest activated segments in heart failure patients eligible for CRT. Presence of LV dyssynchrony can be observed in all QRS configurations. The site of latest activation may be outside the lateral or posterior segment, making echocardiographic assessment of LV dyssynchrony and site of latest activation a valuable technique to optimize patient outcome after CRT.
American heart journal 06/2011; 161(6):1060-6. · 4.65 Impact Factor
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ABSTRACT: Aims of this study were to investigate the effect of renal function on left ventricular (LV) reverse remodeling and long-term outcome after cardiac resynchronization therapy (CRT), and to explore the relation between LV reverse remodeling and changes in renal function at 6-month follow-up.
Renal insufficiency is highly prevalent in heart failure patients, including patients eligible for CRT, and is associated with poor prognosis.
The study comprised 490 patients undergoing CRT. Response to CRT was defined as a decrease in LV end-systolic volume ≥15% at 6-month follow-up. Primary end point during long-term follow-up was all-cause mortality.
At baseline, mean estimated glomerular filtration rate (eGFR) was 70 ± 28 ml/min/1.73 m². At 6-month follow-up, 263 patients (54%) demonstrated response to CRT. Responders had an eGFR of 74 ± 26 ml/min/1.73 m² versus 64 ± 28 ml/min/1.73 m² in nonresponders (p < 0.001). During long-term follow-up, patients with an eGFR <60 ml/min/1.73 m² had higher mortality than patients with an eGFR of 60 to 90 ml/min/1.73 m² or an eGFR >90 ml/min/1.73 m² (p < 0.001). Finally, responders to CRT had preservation of renal function (ΔeGFR -0.6), whereas nonresponders had a slight worsening in renal function (ΔeGFR -4.7, p < 0.05).
Impaired renal function in CRT candidates is associated with nonresponse during 6-month follow-up. Additionally, patients with impaired renal function have worse long-term survival after CRT. Response to CRT results in preservation of renal function.
Journal of the American College of Cardiology 02/2011; 57(5):549-55. · 14.16 Impact Factor
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ABSTRACT: The purpose of the present study was to assess the evolution of left ventricular (LV) function after acute myocardial infarction (AMI) using global longitudinal peak systolic strain (GLPSS) during 1 year follow-up. In addition, patients were divided in groups with early, late, or no improvement of LV function and predictors of recovery of LV function were established.
A total of 341 patients with AMI were evaluated. Two-dimensional echocardiography was performed at baseline, 3, 6, and 12 months. At baseline, LV function was assessed with traditional parameters and GLPSS. Global longitudinal peak systolic strain was re-assessed at 3, 6, and 12 months. Improvement of LV function was based on GLPSS and was observed in 72% of the patients. No differences were observed between patients with early and late improvement. The left anterior descending coronary artery as culprit vessel, peak cardiac troponin T level, diastolic function, and baseline GLPSS were identified as independent predictors of recovery of LV function.
Improvement of LV systolic function occurred in the majority of patients during follow-up. Global longitudinal peak systolic strain, left anterior descending coronary artery as culprit vessel, peak cardiac troponin T level, and diastolic function were independent predictors of recovery of LV function. Quantification of GLPSS may be of important value for the prediction of recovery of LV function in patients after AMI.
European Heart Journal 08/2010; 31(16):2006-13. · 10.48 Impact Factor
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ABSTRACT: Recently, strain and strain rate have been introduced as novel parameters reflecting left ventricular (LV) function. The purpose of the current study was to assess the prognostic importance of strain and strain rate after acute myocardial infarction (AMI).
A total of 659 patients after AMI were evaluated. Baseline echocardiography was performed to assess LV function with traditional parameters and strain and strain rate. During follow-up, 51 patients (8%) reached the primary endpoint (all-cause mortality) and 142 patients (22%) the secondary endpoint (a composite of revascularization, re-infarction, and hospitalization for heart failure). Strain and strain rate were both significantly related with all endpoints. After adjusting for clinical and echocardiographic parameters, strain was independent related to all endpoints and was found to be superior to LV ejection fraction (LVEF) and wall motion score index (WMSI). Patients with global strain and strain rate higher than -15.1% and -1.06 s(-1) demonstrated HRs of 4.5 (95% CI 2.1-9.7) and 4.4 (95% CI 2.0-9.5) for all-cause mortality, respectively.
Strain and strain rate provide strong prognostic information in patients after AMI. These novel parameters were superior to LVEF and WMSI in the risk stratification for long-term outcome.
European Heart Journal 07/2010; 31(13):1640-7. · 10.48 Impact Factor
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ABSTRACT: The extent of viable myocardial tissue is recognized as a major determinant of recovery of left ventricular (LV) function after myocardial infarction. In the current study, the role of global LV strain assessed with novel automated function imaging (AFI) to predict functional recovery after acute infarction was evaluated.
A total of 147 patients (mean age, 61+/-11 years) admitted for acute myocardial infarction were included. All patients underwent 2D echocardiography within 48 hours of admission. Significant relations were observed between baseline AFI global LV strain and peak level of troponin T (r=0.64), peak level of creatine phosphokinase (r=0.62), wall motion score index (r=0.52), and viability index assessed with single-photon emission computed tomography (r=0.79). At 1-year follow-up, LV ejection fraction was reassessed. Patients with absolute improvement in LV ejection fraction > or =5% at 1-year follow-up (n=70; 48%) had a higher (more negative) baseline AFI global LV strain (P<0.0001). Baseline AFI global LV strain was a predictor for change in LV ejection fraction at 1-year follow-up. A cutoff value for baseline AFI global LV strain of -13.7% yielded a sensitivity of 86% and a specificity of 74% to predict LV functional recovery at 1-year follow-up.
AFI global LV strain early after acute myocardial infarction reflects myocardial viability and predicts recovery of LV function at 1-year follow-up.
Circulation Cardiovascular Imaging 10/2009; 3(1):15-23. · 5.94 Impact Factor
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ABSTRACT: The purpose of the present study was to compare longitudinal strain assessed by two-dimensional speckle tracking with scar tissue on contrast-enhanced magnetic resonance imaging (MRI) in patients with chronic ischemic left ventricular (LV) dysfunction. The aim was also to define a cutoff value for regional strain to discriminate between viable myocardium and transmural scar. Ninety patients with chronic ischemic LV dysfunction underwent transthoracic echocardiography to measure global and segmental (regional) longitudinal LV strain using two-dimensional speckle tracking and cine MRI followed by contrast-enhanced MRI to assess segmental LV function and the segmental/global (transmural) extent of scar tissue. The optimal cutoff value for regional strain to discriminate between segments with viable myocardium and segments with transmural scar was also determined. A good correlation was found between global LV strain and the global extent of scar tissue on contrast-enhanced MRI (R = 0.62, p <0.001). The mean segmental strain in segments without scar tissue was -10.4% +/- 5.2% compared with 0.6% +/- 4.9% in segments with transmural scar tissue (p <0.001). A strain value of -4.5% discriminated between segments with viable myocardium and segments with transmural scar tissue on contrast-enhanced MRI with a sensitivity of 81.2% and specificity of 81.6%. In conclusion, global and regional longitudinal strain measured with two-dimensional speckle tracking is associated with the global and regional (transmural) extent of scar tissue on contrast-enhanced MRI. A cutoff value of -4.5% for regional strain discriminated between segments with viable myocardium and those with transmural scar tissue on contrast-enhanced MRI with a sensitivity of 81.2% and specificity of 81.6%.
The American journal of cardiology 09/2009; 104(3):312-7. · 3.58 Impact Factor
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ABSTRACT: Besides implantation of an implantable cardioverter-defibrillator (ICD), a proportion of patients with left ventricular (LV) dysfunction due to ischemic cardiomyopathy are potential candidates for surgical LV reconstruction (Dor procedure), which changes LV ejection fraction (LVEF) considerably. In these patients, LVEF as selection criterium for ICD implantation may be difficult. This study aimed to determine the value of LVEF as criterium for ICD implantation in heart failure patients undergoing surgical LV reconstruction.
Consecutive patients with end-stage heart failure who underwent ICD implantation and LV reconstruction were evaluated. During admission, two-dimensional (2D) echocardiography (LV volumes and LVEF) was performed before surgery and was repeated at 3 months after surgery. Over a median follow-up of 18 months, the incidence of ICD therapy was evaluated.
The study population consisted of 37 patients (59 +/- 11 years). At baseline, mean LVEF was 23 +/- 5%. Mean left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) were 175 +/- 73 mL and 225 +/- 88 mL, respectively. At 3-month follow-up, mean LVEF was 41 +/- 9% (P < 0.0001 vs. baseline), and mean LVESV and LVEDV were 108 +/- 65 mL and 176 +/- 73 mL, respectively (P < 0.0001 vs. baseline). During 18-month follow-up, 12 (32%) patients had ventricular arrhythmias, resulting in appropriate ICD therapy. No significant relations existed between baseline LVEF (P = 0.77), LVEF at 3-month follow-up (P = 0.34), change in LVEF from baseline to 3-month follow-up (P = 0.28), and the occurrence of ICD therapy during 18-month follow-up.
LVEF before and after surgical LV reconstruction is of limited use as criterium for ICD implantation in patients with end-stage heart failure.
Pacing and Clinical Electrophysiology 08/2009; 32(7):913-7. · 1.35 Impact Factor
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ABSTRACT: The relation between cardiac troponin T (cTnT) and regional strain in patients with acute myocardial infarction (AMI) was investigated. Furthermore, the effect of symptoms-to-balloon time on impairment in regional strain after AMI was evaluated. A total of 157 consecutive patients with AMI who underwent primary percutaneous coronary intervention were included. Two-dimensional echocardiography soon after percutaneous coronary intervention was performed. Speckle-tracking analysis was applied to assess left ventricular global and regional longitudinal peak systolic strain (LPSS). Infarcted area was defined based on the culprit vessel. Mean left ventricular ejection fraction was 47 +/- 7%. Global LPSS was -14.4 +/- 3.2%. The infarcted area LPSS was significantly decreased compared with global LPSS (-11.3 +/- 4.5%, p <0.001). The major reflector of cTnT was infarcted area LPSS (beta 0.47, p <0.001). Mean symptoms-to-balloon time was 212 +/- 92 minutes. Based on this time, the study population was divided in tertiles. In the group with the shortest symptoms-to-balloon time, global LPSS and infarcted area LPSS were less impaired compared with groups with longer symptoms-to-balloon time (p <0.01 for the 2 comparisons). In conclusion, myocardial strain was related to peak levels of cTnT, thus reflecting damage after AMI. Early reperfusion resulted in decreased myocardial damage in the infarcted area as quantified with strain.
The American journal of cardiology 08/2009; 104(4):480-5. · 3.58 Impact Factor
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ABSTRACT: Alcohol septal ablation (ASA) aims to decrease left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (HC). To date, no diagnostic variables at baseline are available to predict long-term success of the procedure. We hypothesized that an immediate decrease in septal longitudinal strain after ASA would be associated with sustained LVOT gradient decrease after 6 months. ASA was performed in 22 patients with HC and severe drug-refractory symptoms. Clinical evaluation and 2-dimensional echocardiography were performed before, 1 day after, and 6 months after ASA. During 6-month follow-up, New York Heart Association class improved (2.7 +/- 0.5 vs 1.4 +/- 0.6, p <0.01) and LVOT gradient decreased (68 +/- 31 vs 21 +/- 21 mm Hg, p <0.01). Strain evaluation showed considerable decreases in basal septal strain (-12 +/- 3% vs -8 +/- 2%, p <0.01) and midseptal strain (-13 +/- 4% vs -8 +/- 3%, p <0.01) 1 day after ASA. Decreases in basal septal and midseptal strain 1 day after ASA were strongly related to the decrease in LVOT gradient during 6-month follow-up (r = 0.70, p <0.01, and r = 0.65, p <0.01, respectively). In conclusion, in patients with HC and severe drug-refractory symptoms, immediate decrease in septal strain after ASA is strongly related to a decrease in LVOT gradient after 6 months and might therefore serve as an early determinant for long-term success of the ASA procedure.
The American journal of cardiology 06/2009; 103(11):1592-7. · 3.58 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the acute and late effects of cardiac resynchronization therapy (CRT) on multidirectional left ventricular (LV) strain assessed by two-dimensional speckle-tracking imaging and automated function imaging (AFI).
Multidirectional LV strain (global radial strain [GRS Avg], global circumferential strain [GCS Avg], and global longitudinal peak systolic strain [GLPSS Avg]) were measured in 141 patients with heart failure before CRT implantation, immediately afterward, and after 3 to 6 months of follow-up. Moreover, the acute effects on multidirectional LV strain were evaluated after interrupting CRT at follow-up. Response to CRT was defined as a decrease in LV end-systolic volume > or = 15%.
Responders (57%) and nonresponders (43%) showed similar baseline values for GRS Avg, GCS Avg, and GLPSS Avg. At follow-up, significant improvement in multidirectional LV strain, combined with significant reverse LV remodeling and improvement in LV ejection fraction, was noted only in responders. Importantly, no significant changes in multidirectional LV strain were observed immediately after CRT device implantation or after device interruption at follow-up.
Two-dimensional speckle-tracking imaging and AFI enable the quantification of multidirectional LV mechanics. Improvement in LV strain in the 3 orthogonal directions after CRT appears to be a long-term effect and is related to the extent of reverse LV remodeling after CRT.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 06/2009; 22(6):688-94. · 2.98 Impact Factor
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ABSTRACT: Echocardiography is useful for risk stratification and assessment of prognosis after myocardial infarction, which is the focus of this review. Various traditional echocardiographic parameters have been shown to provide prognostic information, such as left ventricular volumes and ejection fraction, wall motion score index, mitral regurgitation and left atrial volume. The introduction of tissue Doppler imaging and speckle-tracking strain imaging has resulted in additional prognostic parameters, such as left ventricular strain (rate) and dyssynchrony. Also, (myocardial) contrast echocardiography provides valuable information, particularly about myocardial perfusion (as a marker of myocardial viability), which is strongly related to prognosis after myocardial infarction. Stress echocardiography provides information on ischaemia and viability, coronary flow reserve can be obtained by Doppler imaging of the coronary arteries, and finally, three-dimensional echocardiography provides optimal information on left ventricular volumes, function and sphericity, which are also important for long-term outcome.
Heart (British Cardiac Society) 04/2009; 95(21):1732-45. · 4.22 Impact Factor
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ABSTRACT: Automated function imaging (AFI) is a novel algorithm based on speckle-tracking imaging that can be used for assessment of global longitudinal strain of the left ventricle. The purpose of this study was to evaluate the relation between global longitudinal peak systolic strain average (GLPSS Avg) assessed by AFI and left ventricular ejection fraction (LVEF).
The study population consisted of 222 consecutive patients with coronary artery disease (99 patients with acute ST-segment elevation myocardial infarction [STEMI] and 123 patients with advanced ischemic heart failure) and 20 age-matched controls. LVEF was calculated by Simpson's rule. The GLPSS Avg was obtained by AFI.
In the overall study group (65 +/- 10 years, 77% were men), mean GLPSS Avg was 11.1% +/- 4.8% and mean LVEF was 37% +/- 14%. Linear regression analysis showed a good correlation between GLPSS Avg and biplane LVEF for the overall study population (r = 0.83; P < .001). However, in patients with STEMI or heart failure the correlations were less strong (r = 0.42 and r = 0.62, both P < .001).
Systolic global longitudinal strain assessed by AFI was linearly related to biplane LVEF. In patients with STEMI or heart failure, less strong correlations were observed, suggesting that these 2 parameters reflect different aspects of systolic left ventricular function.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 11/2008; 21(11):1244-50. · 2.98 Impact Factor
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ABSTRACT: The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position.
A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT.
The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest X-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure.
Significant LV reverse remodeling (reduction in LV end-systolic volume from 189 +/- 83 ml to 134 +/- 71 ml, p < 0.001) was noted in the group of patients with a concordant LV lead position (n = 153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32 +/- 16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, p = 0.004).
Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up.
Journal of the American College of Cardiology 10/2008; 52(17):1402-9. · 14.16 Impact Factor
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ABSTRACT: The objective of this study was to assess the usefulness of each type of strain for left ventricular (LV) dyssynchrony assessment and its predictive value for a positive response after cardiac resynchronization therapy (CRT). Furthermore, changes in extent of LV dyssynchrony for each type of strain were evaluated during follow-up.
Different echocardiographic techniques have been proposed for assessment of LV dyssynchrony. The novel 2-dimensional (2D) speckle tracking strain analysis technique can provide information on radial strain (RS), circumferential strain (CS), and longitudinal strain (LS).
In 161 patients, 2D echocardiography was performed at baseline and after 6 months of CRT. Extent of LV dyssynchrony was calculated for each type of strain. Response to CRT was defined as a decrease in LV end-systolic volume >/=15% at follow-up.
At follow-up, 88 patients (55%) were classified as responders. Differences in baseline LV dyssynchrony between responders and nonresponders were noted only for RS (251 +/- 138 ms vs. 94 +/- 65 ms; p < 0.001), whereas no differences were noted for CS and LS. A cut-off value of radial dyssynchrony >/=130 ms was able to predict response to CRT with a sensitivity of 83% and a specificity of 80%. In addition, a significant decrease in extent of LV dyssynchrony measured with RS (from 251 +/- 138 ms to 98 +/- 92 ms; p < 0.001) was demonstrated only in responders.
Speckle tracking radial strain analysis constitutes the best method to identify potential responders to CRT. Reduction in LV dyssynchrony after CRT was only noted in responders.
Journal of the American College of Cardiology 05/2008; 51(20):1944-52. · 14.16 Impact Factor
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ABSTRACT: To evaluate the effect of bone marrow cell injection on global strain and left ventricular (LV) dyssynchrony.
In 14 patients with severe postinfarction heart failure, 93 (14) x 10(6) autologous bone marrow cells were percutaneously injected in the infarction border zone. LV ejection fraction (LVEF), LV dyssynchrony and echocardiographic global strain were assessed at baseline and 3 months in patients and in a non-randomised control group of 10 patients with a history of infarction who developed heart failure and were treated medically.
No periprocedural complications occurred during bone marrow cell injection. At 3 months mean (SD) LVEF increased from 23 (8)% to 27 (9)% (p = 0.02) and global strain improved from -7.7 (4.7)% to -8.5 (4.9)% (p = 0.04). In patients with > or =5% improvement in LVEF after bone marrow cell injection, global strain improved from -8.7 (4.6)% to -10.6 (4.5)% (p<0.01). Global strain remained unchanged in patients with <5% improvement in LVEF (-6.6 (4.9)% vs -6.4 (4.5)%, p = NS). The relation between the increase in LVEF and improvement in global strain was significant (r = 0.84, p<0.01). In patients with > or =5% improvement in LVEF, LV dyssynchrony decreased from 173 (64) ms to 116 (64) ms (p = 0.01). In patients with <5% improvement in LVEF, LV dyssynchrony remained unchanged (155 (67) ms vs 177 (81) ms, p = NS). The correlation between improvement in LVEF and reduction in LV dyssynchrony was good (r = -0.77, p<0.01). In the control group, LVEF, global strain and LV dyssynchrony did not improve.
Bone marrow cell injection improves LVEF in patients with severe postinfarction heart failure. The improvement in LVEF was related to reduced LV dyssynchrony and increased global strain.
Heart (British Cardiac Society) 01/2008; 95(2):119-24. · 4.22 Impact Factor
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ABSTRACT: Despite current selection criteria, 20% to 30% of patients treated with cardiac resynchronization therapy (CRT) do not benefit. It has been suggested that QRS duration may not be the optimal criterion to select patients for CRT. The objective of this study was to systematically evaluate the predictive value of QRS duration for response to CRT in a large group of consecutive patients. A total of 242 patients with heart failure scheduled for implantation of a CRT device were studied. Selection criteria for CRT included moderate to severe heart failure (New York Heart Association classes III to IV), left ventricular ejection fraction (LVEF)<or=35%, and QRS duration>120 ms. Before CRT implantation, QRS duration and clinical status were assessed, and 2-dimensional echocardiography (LV volumes and LVEF) was performed. Clinical status and changes in LVEF and LV volumes were reassessed at 6-month follow-up. After 6 months of CRT, 68% of patients were classified as clinical responders (improvement of >or=1 grade in New York Heart Association class) and 60% as echocardiographic responders (decrease>10% in LV end-systolic volume). At baseline, no significant differences were observed in QRS duration between clinical responders and nonresponders and between echocardiographic responders and nonresponders. No significant relation was demonstrated between baseline QRS duration and improvement in clinical and echocardiographic variables at 6-month follow-up. In conclusion, baseline QRS duration is not predictive for clinical and echocardiographic responses to CRT at 6-month follow-up. Better predictors for CRT response are needed.
The American Journal of Cardiology 12/2007; 100(11):1665-70. · 3.37 Impact Factor
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Sjoerd A Mollema,
Su San Liem,
Matthew S Suffoletto,
Gabe B Bleeker,
Bas L van der Hoeven,
Nico R van de Veire,
Eric Boersma,
Eduard R Holman,
Ernst E van der Wall,
Martin J Schalij,
John Gorcsan,
Jeroen J Bax
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ABSTRACT: We sought to identify predictors of left ventricular (LV) remodeling after acute myocardial infarction.
Left ventricular remodeling after myocardial infarction is associated with an adverse long-term prognosis. Early identification of patients prone to LV remodeling is needed to optimize therapeutic management.
A total of 178 consecutive patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention were included. Within 48 h of intervention, 2-dimensional echocardiography was performed to assess LV volumes, LV ejection fraction (LVEF), wall motion score index, left atrial dimension, E/E' ratio, and severity of mitral regurgitation. Left ventricular dyssynchrony was determined using speckle-tracking radial strain analysis. At 6-month follow-up, LV volumes, LVEF, and severity of mitral regurgitation were reassessed.
Patients showing LV remodeling at 6-month follow-up (20%) had comparable baseline characteristics to patients without LV remodeling (80%), except for higher peak troponin T levels (p < 0.001), peak creatine phosphokinase levels (p < 0.001), wall motion score index (p < 0.05), E/E' ratio (p < 0.05), and a larger extent of LV dyssynchrony (p < 0.001). Multivariable analysis demonstrated that LV dyssynchrony was superior in predicting LV remodeling. Receiver-operating characteristic curve analysis demonstrated that a cutoff value of 130 ms for LV dyssynchrony yields a sensitivity of 82% and a specificity of 95% to predict LV remodeling at 6-month follow-up.
Left ventricular dyssynchrony immediately after acute myocardial infarction predicts LV remodeling at 6-month follow-up.
Journal of the American College of Cardiology 10/2007; 50(16):1532-40. · 14.16 Impact Factor
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ABSTRACT: Reverse remodeling of the left ventricle (LV) is one of the advantageous mechanisms of cardiac resynchronization therapy (CRT). Substantial LV dyssynchrony seems mandatory for echocardiographic response to CRT. Conversely, LV dyssynchrony early after acute myocardial infarction may result in LV dilatation during follow-up.
The purpose of this study was to evaluate the relation between LV dyssynchrony early after acute myocardial infarction and the occurrence of long-term LV dilatation.
A total of 124 consecutive patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention were included. Within 48 hours of intervention, two-dimensional echocardiography was performed to assess LV volumes, LV ejection fraction (LVEF), and wall motion score index (WMSI). LV dyssynchrony was quantified using color-coded tissue Doppler imaging (TDI). At 6-month follow-up, LV volumes and LVEF were reassessed.
Patients with substantial LV dyssynchrony (> or =65 ms) at baseline (18%) had comparable baseline characteristics to patients without substantial LV dyssynchrony (82%), except for a higher prevalence of multivessel coronary artery disease (P = .019), higher WMSI (P = .042), and higher peak levels of creatine phosphokinase (P = .021). During 6 months of follow-up, 91% of the patients with substantial LV dyssynchrony at baseline developed LV remodeling, compared with 2% in the patients without substantial LV dyssynchrony. LV dyssynchrony at baseline was strongly related to the extent of long-term LV dilatation at 6 months of follow-up.
Most patients with substantial LV dyssynchrony immediately after acute myocardial infarction develop LV dilatation during 6 months of follow-up.
Heart Rhythm 10/2007; 4(9):1144-8. · 4.10 Impact Factor
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ABSTRACT: Recent studies have demonstrated that a positive response to cardiac resynchronization therapy (CRT) is related to the presence of preimplantation left ventricular (LV) dyssynchrony. The time course and the extent of LV resynchronization after CRT implantation and their relationship to response are currently unknown.
One hundred consecutive patients scheduled for implantation of a CRT device were prospectively included if they met the following criteria: New York Heart Association class III to IV, LV ejection fraction < or = 35%, QRS duration > 120 ms, and LV dyssynchrony (> or = 65 ms) on color-coded tissue Doppler imaging. Immediately after CRT implantation, LV dyssynchrony was reduced from 114+/-36 to 40+/-33 ms (P<0.001), which persisted at the 6-month follow-up (35+/-31 ms; P<0.001 versus baseline; P=0.14 versus immediately after implantation). At the 6-month follow-up, 85% of patients were classified as responders to CRT (defined as > 10% reduction in LV end-systolic volume). Immediately after implantation, the responders to CRT demonstrated a significant reduction in LV dyssynchrony from 115+/-37 to 32+/-23 ms (P<0.001). The nonresponders, however, did not show a significant reduction in LV dyssynchrony (106+/-29 versus 79+/-44 ms; P=0.08). If the extent of acute LV resynchronization was < 20%, response to CRT at the 6-month follow-up was never observed. Conversely, 93% of patients with LV resynchronization > or = 20% responded to CRT.
LV resynchronization after CRT is an acute phenomenon and predicts response to CRT at 6-month follow-up in patients with echocardiographic evidence of LV dyssynchrony at baseline.
Circulation 09/2007; 116(13):1440-8. · 14.74 Impact Factor
