Left ventricular global longitudinal strain and mechanical dispersion predict response to multipoint pacing for cardiac resynchronization therapy

2019 ◽  
Vol 47 (6) ◽  
pp. 356-365 ◽  
Author(s):  
Mengruo Zhu ◽  
Haiyan Chen ◽  
Zibire Fulati ◽  
Yang Liu ◽  
Yangang Su ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Multipoint Pacing ◽  
Mechanical Dispersion

Abstract 2819: Identification and Characterization of Super-Responders to Cardiac Resynchronization Therapy: An Echocardiographic Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Amira Zaroui ◽  
Patricia Reant ◽  
Erwan Donal ◽  
Aude Mignot ◽  
Pierre Bordachar ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
End Systolic Volume

In some patients, cardiac resynchronization therapy (CRT) has been recently shown to induce a spectacular effect on left ventricular (LV) function and inverted remodeling with nearby normalization of LV contraction. Objectives: To analyze and characterize super-responders (CRTSR) by echocardiography before CRT. 186 patients have been investigated before and 6 months after implantation of a CRT device with conventional indication according to ESC guidelines. Echocardiographies including measurements of LV dimensions, and contraction by 2-dimensional strain, and pressure assessment, mitral valve analysis were performed at baseline and at 6 months in an independent core-center lab. CRTSR were defined as a reduction of end-systolic volume of at least 15% and an ejection fraction (EF)>50% and were compared to normal responder patients (CRTNo, patients with a reduction of end-systolic volume of at least 15% but an EF <50%). 17/186 patients (9.1%) were identified as CRTSR, only 2 with ischemic cardiomyopathy (p<0.01). No difference was observed regarding NYHA status, EKG duration or EF between CRTSR and CRTNo at baseline. CRTSR presented with significant lower end-diastolic and end-systolic diameters (64±9mm vs 73±9mm (p<0.01) and 53±7.4mm vs 63±8.4mm (p<0.01), respectively), and end-diastolic and end-systolic volumes 161±44ml vs 210±76ml (p<0.02) and 123±43ml vs 163±69ml (p<0.01)) as well as a higher LV dP/dt max (714±251mmHg.s −1 vs 527±188 mmHg.s −1 (p<0.05)). Regarding strain analysis, CRTSR had significantly higher longitudinal values than CRTNo (−12.8±3% vs −9±2.6%, p<0.001) whereas no difference was observed for other components (p ns). Global longitudinal strain obtained by ROC curves was identified as the best parameter for predicting CRTSR with a cut-off value of −11% (Se=80%, Spe=87%, AUC=0.89, p<0.002) and was confirmed as an independent predictor by the logistic regression (RR: 21.3, p<0.0001). In a large multicenter study, CRT super-responders (EF>50%) were observed in 9% of the population and were associated with less-depressed LV function as determined by strain analysis. Global longitudinal strain appears to be the best predictor of CRTSR.

scholarly journals Left ventricular remodelling and change in left ventricular global longitudinal strain after cardiac resynchronization therapy: prognostic implications

2019 ◽  
Vol 20 (10) ◽  
pp. 1112-1119 ◽  
Author(s):  
Pieter van der Bijl ◽  
Marina V Kostyukevich ◽  
Mand Khidir ◽  
Nina Ajmone Marsan ◽  
Victoria Delgado ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
Reverse Remodelling ◽  
Prognostic Implications

Abstract Aims Cardiac resynchronization therapy (CRT) can reduce left ventricular end-systolic volume (LVESV), and a decrease of ≥15% is defined as a response. CRT can also improve LV global longitudinal strain (GLS). Changes in LVESV and LV GLS are individually associated with outcome post-CRT. We investigated LVESV and LV GLS changes and prognostic implications of improvement in LVESV and/or LV GLS, compared with no improvement in either parameter. Methods and results Baseline and 6-month echocardiograms were analysed from CRT recipients with heart failure. LV reverse remodelling was defined as a ≥15% reduction in LVESV at 6 months post-CRT. A ≥5% absolute improvement in LV GLS was defined as a change in LV GLS. A total of 1185 patients were included (mean age 65 ± 10 years, 73% male), and those with an improvement in LVESV and LV GLS (n = 131, 11.1%) had significantly lower mortality compared with other groups. On multivariable analysis, an improvement in both LVESV and LV GLS [hazard ratio (HR): 0.47; 95% confidence interval (CI): 0.31–0.71; P < 0.001] or an improvement in either LVESV or LV GLS (HR: 0.57; 95% CI: 0.47–0.71; P < 0.001) were independently associated with better prognosis, compared with no improvement in either parameter. Conclusion Either a reduction in LVESV and/or an improvement in LV GLS at 6 months post-CRT are independently associated with improved long-term prognosis, compared with no change in both LVESV and LV GLS. This supports the use of LV GLS as a meaningful parameter in defining CRT response.

Abstract 15815: Left Atrial Strain Characterizes the Atrio-ventricular Substrate Responsive to Cardiac Resynchronization Therapy in Patients With Intermediate Electrocardiographic Criteria

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Peter Huntjens ◽  
Masataka Sugahara ◽  
Yuko Soyama ◽  
Joost Lumens ◽  
Mitchell N Faddis ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Atrial ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
High Peak ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Ecg Criteria

Introduction: Guidelines favor patient selection by left bundle branch block (LBBB) with QRS width ≥150 ms for cardiac resynchronization therapy (CRT). Predicting CRT response in patients with QRS width 120 to 149 ms or non-LBBB remains difficult. Left ventricular (LV) global longitudinal strain (GLS) and systolic stretch index (SSI) have shown to characterize the ventricular substrate responsive to CRT. However, the potential application of longitudinal left atrial (LA) strain remains unclear. Hypothesis: Baseline LA strain has prognostic value in CRT patients with intermediate ECG criteria. Methods: We studied 195 patients who underwent CRT based on routine indications: ejection fraction ≤35% and QRS width ≥120 ms. GLS was assessed using the 3 standard apical views. Radial SSI was derived from the mid LV short axis view. Peak longitudinal LA strain was derived from the 2 and 4-chamber apical view. The predefined combined clinical endpoint was death, heart transplant or left ventricular assist device over 4 years after CRT. Results: LA strain was feasible in 162 (83%) of the CRT candidates: QRS duration 156 ± 26 ms, 39.5% had LBBB with QRS ≥ 150ms, 60.5% had intermediate ECG criteria. High peak longitudinal strain (>median, 10.1%) was associated with favorable event-free survival (p<0.001). Patients with intermediate ECG criteria for CRT and both high peak longitudinal LA strain and high GLS (>median, 8.4%) had similar outcome to those with Class I indications for CRT. Multivariable analysis revealed that LA strain had independent prognostic value (hazard ratio 0.9 per LA strain %, p < 0.001) even after adjusted for other clinical, electrophysiological and echocardiographic covariates including QRS morphology and duration, GLS and SSI. Conclusions: Peak LA strain had important prognostic value in candidates for CRT. Prognostic value of LA strain was additive to LV strain characteristics and most significant in CRT patients with intermediate ECG criteria for CRT.

scholarly journals New capabilities in assessing the left ventricular contractility by two-dimensional speckle tracking echocardiography

2020 ◽  
Vol 35 (3) ◽  
pp. 79-85
Author(s):  
V. E. Oleynikov ◽  
Yu. G. Smirnov ◽  
V. A. Galimskaya ◽  
E. A. Gundarev ◽  
N. V. Burko
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Two Dimensional ◽  
Ventricular Contractility ◽  
Resynchronization Therapy ◽  
Clinical Implementation

This work reviews the reasons why the characteristics of left ventricular (LV) contractility, in particular, and 2D speckle echocardiography-based peak rates of global longitudinal strain (GLS), are not widely used in clinical practice. Authors present the analysis of new indicators proposed for the assessment ofLVcontractile function based on longitudinal strain taking into account the involvement of individual segments. The authors show that the assessment of myocardial work indicators characterizing the relationships between contractile and pump functions is a promising approach for the study ofLVcontractile function. The analysis of postsystolic strain index (PSI) is presented to illustrate its clinical implementation in the studies of viable myocardium in ischemic conditions and evaluating the effectiveness of cardiac resynchronization therapy (CRT).

scholarly journals P366 Role of mechanical dispersion in the prediction of heart failure admissions in dilated non ischemic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Travieso Gonzalez ◽  
M Ferrandez Escarabajal ◽  
F Islas ◽  
M Luaces ◽  
L Perez De Isla ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
Mechanical Dispersion ◽  
End Diastolic Volume ◽  
2D Speckle Tracking ◽  
Baseline Characteristics

Abstract Introduction Non ischemic dilated cardiomyopathy (DCM) is a disease with poor prognosis and limited therapeutic options. Several echocardiographic measures attempt to provide good estimators of the risk of heart failure (HF) admissions. Purpose To assess the potential additional value of mechanical dispersion (MD) compared to global longitudinal strain (GLS) in the prediction of outcomes in DCM. Methods 74 patients with DCM and left ventricle ejection fraction (LVEF) of less than 50% were prospectively evaluated from 2015 to 2019. MD and GLS were blindly measured using 2D speckle tracking echocardiography. Hospital admissions due to worsening HF were examined. Results Mean LVEF was 29.4%, and median follow-up time was 14 months. Baseline characteristics are shown in Table 1. Patients with high MD, defined as &gt;67 ms, showed a significantly higher risk of admissions due to HF (50.5% vs 22.0%, p = 0.026), even when adjusted with LVEF and end-diastolic volume in multivariable analysis, with a hazard ratio of 2.6 (95% confidence interval 1.1-6.1) (Figure). No differences in the use of cardiac resynchronization therapy and implantable cardioverter defibrillator were observed in both groups. This cut off value had a Sensitivity of 52.2% and Specificity of 76.5%. Despite significant correlation between MD and GLS (R = 0.36, p = 0.002), a GLS of less than -10% was not significantly associated with higher incidence of HF admissions in this population (40.6% vs 23.8%, p = 0.229). Conclusion Mechanical dispersion, measured by 2D speckle tracking echocardiography, predicts HF admissions more accurately than global longitudinal strain in patients with non-ischemic DCM. Table 1 Mech. Disp &lt;67 ms (n = 50) Mech. Disp ≥67 ms (n = 24) p Age 62.2 (±2.2) 64.6 (±3.0) 0.538 Female sex 13 (26.0%) 10 (41.7%) 0.173 NYHA class III-IV 4 (8.5%) 3 (13.6%) 0.882 CRT 23 (46.0%) 12 (50.0%) 0.747 ICD 27 (54.0%) 17 (70.0%) 0.167 QRS duration (ms) 144.2 (±8.6) 152.7 (±7.9) 0.496 NTproBNP (pg/ml) 4495 (±964) 4488 (±1529) 0.997 LVEF (%) 29.9 (±1.1) 28.6 (±1.7) 0.520 LVEDV (ml/m2) 93.0 (±5.6) 95.2 (±5.8) 0.802 Table 1: baseline characteristics in population with MD &lt;67 ms or ≥ MS. Data is shown as N(%) or Mean(±SD). CRT: cardiac resynchronization therapy. ICD: implantable cardioverter defibrillator. LVEDV: LV end-diastolic volume. Abstract P366 Figure

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