Afterload Hypersensitivity in Patients With Left Bundle Branch Block

Aalen, John M.; Storsten, Petter; Remme, Espen W.; Sirnes, Per Anton; Gjesdal, Ola; Larsen, C K; Kongsgaard, Erik; Skulstad, Helge; Hisdal, Jonny; Smiseth, Otto A.

doi:10.1016/j.jcmg.2017.11.025

Cited by 42 publications

(24 citation statements)

References 29 publications

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“…Therefore, not only septal deformation pattern, but also septal pump function was markedly improved when the LV lateral wall was dysfunctional. In a recent study of patients with LBBB we also demonstrated a strong afterload dependency of septal motion (28). In that study we showed aggravation of septal dysfunction with enhanced septal rebound stretch during acute elevation of aortic pressure (28).…”

Section: Modifiers Of Abnormal Septal Motion In Lbbbsupporting

confidence: 58%

Mechanism of Abnormal Septal Motion in Left Bundle Branch Block

Aalen

Remme

Larsen

et al. 2019

JACC: Cardiovascular Imaging

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Objectives: This study sought to investigate how regional left ventricular (LV) function modifies septal motion in left bundle branch block (LBBB). Background: In LBBB the interventricular septum often has marked pre-ejection shortening, followed by immediate re-lengthening (rebound stretch). This motion, often referred to as septal flash, is associated with positive response to cardiac resynchronization therapy (CRT). Methods: In 10 anesthetized dogs we induced LBBB by radiofrequency ablation and occluded the circumflex (CX) (n=10) and left anterior descending (LAD) (n=6) coronary arteries, respectively. Myocardial dimensions were measured by sonomicrometry and myocardial work by pressure-segment length analysis. In 40 heart failure patients with LBBB, including 20 with post-infarct scar and 20 with non-ischemic cardiomyopathy, myocardial strain was measured by speckle-tracking echocardiography and myocardial work by pressurestrain analysis. Scar was assessed by cardiac magnetic resonance imaging with late gadolinium enhancement. Results: During LBBB each animal showed typical septal flash with pre-ejection shortening and rebound stretch, and reduced septal systolic shortening (p<0.01). CX occlusion caused LV lateral wall dysfunction and abolished septal flash due to loss of rebound stretch (p<0.0001). Furthermore, CX occlusion restored septal systolic shortening to similar level as before induction of LBBB and substantially improved septal work (p<0.001). LAD occlusion, however, accentuated septal flash by increasing rebound stretch (p<0.05). Consistent with the experimental findings, septal flash was absent in patients with LV lateral wall scar due to lack of rebound stretch (p<0.001), and septal systolic shortening and septal work far exceeded values in non-ischemic cardiomyopathy (p<0.0001). Septal flash was present in most patients with anteroseptal scar. Conclusions: LV lateral wall dysfunction and scar abolished septal flash and markedly improved septal function in LBBB. Therefore, function and scar in the LV lateral wall should be taken into account when using septal motion to evaluate dyssynchrony.

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Section: Modifiers Of Abnormal Septal Motion In Lbbbsupporting

confidence: 58%

Mechanism of Abnormal Septal Motion in Left Bundle Branch Block

Aalen

Remme

Larsen

et al. 2019

JACC: Cardiovascular Imaging

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“…Esse modelo associado ao MultiPatch Module, apresentado por Walmsley et al, 11 pode retornar curvas de strain correspondentes às simulações e os tempos de eventos mecânicos, sem sinais de ECG, como mostrado na Figura 6. Dessa forma, o software desenvolvido pode trabalhar com modelos cardíacos virtuais elaborados seguindo o trabalho de Walmsley et al [11][12][13][14] Possibilidade de aplicação de técnicas de aprendizado de máquina (Machine Learning) Machine learning consiste em uma área do campo da inteligência artificial capaz de processar problemas complexos de interação entre variáveis e fazer predições acuradas. Tem sido amplamente utilizada em diferentes áreas da cardiologia.…”

Section: Resultsunclassified

“…A interface do D-Station com o modelo Circadapt associado ao MultiPatch Module permite formulação de hipóteses e comparação com sinais de pacientes reais como já realizado previamente. [12][13][14] Isso gera recursos de ensino da fisiopatologia da deformação cardíaca, além de potencialmente reduzir o tempo da escolha das variáveis de interesse e poupar recursos com elaboração de modelos animais em alguns cenários de pesquisa.…”

Section: Potenciais Aplicações Do Software D-stationunclassified

Apresentação de Software para Pós-processamento de Curvas de Deformação Cardíaca: D-Station

et al. 2020

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ResumoFundamento: O emprego de Speckle Tracking para estudo da função cardíaca tem grande aplicabilidade em diversos cenários. A expansão do uso deste método requer ferramentas que permitam a extração de dados relevantes das curvas de deformação cardíaca e que sejam adicionais aos parâmetros habitualmente utilizados.Objetivos: O presente trabalho visa apresentar e validar um software de uso livre, denominado D-station, para análise das curvas de deformação cardíaca. Métodos: A partir de arquivos raw data, o D-Station realiza a separação das fases do ciclo cardíaco, exibe simultaneamente curvas de Strain e StrainRate de diferentes câmaras cardíacas. Para validação do software utilizamos o parâmetro Global Longitudinal Strain (GLS) avaliando-o: 1) Graficamente, a partir da comparação das Medidas emparelhadas de GLS no EchoPAC e D-Station frente à linha de igualdade; 2) pelo Coeficiente de Correlação dessas medidas; 3) pelo Teste de Hipóteses (p > 0,05); e 4) pelo Método Gráfico de Bland-Altman. Resultados: O Coeficiente rho de Spearman apontou forte correlação entre as medidas, o Teste de Hipóteses retornou um p-value = 0.6798 >> 0,05, que também indicou a equivalência entre elas; o Método gráfico de Bland-Altman mostrou um viés ≤ 1% e dispersão ≤ 2% entre as medidas. Os testes mostraram que para valores de GLS inferiores à 10% há a tendência de aumento das diferenças percentuais, mas seus valores absolutos ainda são baixos. Conclusão: O D-Station foi validado como uma aplicação suplementar ao EchoPAC que utiliza o raw data das curvas de Strain e Strain Rate obtidos por software proprietário. (Arq Bras Cardiol. 2020; 114(3):496-506) Palavras-chave: Doenças Cardiovasculares/diagnóstico por imagem, Prognóstico, Ecocardiografia/métodos, Disfunção Ventricular Esquerda/fisiopatologia, Speckle Tracking. AbstractBackground: The use of speckle-tracking echocardiography for evaluation of cardiac function has great applicability in different scenarios. The broad use of this method requires tools that allow the extraction of relevant data from strain curves and inclusion of these data in traditionally used parameters. Objectives:The present study aimed to present and validate a free software, called D-station, for analysis of strain curves.Methods: From raw data files, the D-Station determines the phases of the cardiac cycle, and simultaneously exhibits the strain and strain rate curves of different cardiac chambers. Validation of the software was done by global longitudinal strain (GLS), and the analyses were performed: 1) graphical comparison of EchoPAC and D-Station paired measurements in relation to equality line; 2) by coefficient of correlation of these measurements; 3) test of hypothesis (p > 0.05); and 4) Bland-Altman analysis. Results:The Spearman's rho correlation coefficient indicated a strong correlation between the measurements. Results of the test of hypothesis showed a p-value = 0.6798 >> 0.05, thus also indicating an equivalence between the softwares. The Bland-Altman analysis revealed a bias ≤ 1% and dispersi...

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“…Aalen et al have shown that the dyssynchronous ventricle is particularly sensitive to increase in LV afterload. This is particularly evident in the septum with respect to the lateral wall [21], and might explain the relationship between septal work efficiency and exercise performance in patients with LV-DYS. In a small cohort of patients undergoing CRT, Zweerink et al have shown that the contribution of the septum to LV work varies widely in CRT candidates and that the lower is the septal contribution to myocardial work at baseline, the higher is the acute pump function improvement that can be achieved with CRT [22].…”

Section: Several Methods Mostly Based On the Analysis Of Timing Of Lomentioning

confidence: 91%

Myocardial work is a predictor of exercise tolerance in patients with dilated cardiomyopathy and left ventricular dyssynchrony

Schrub

Schnell

Donal

et al. 2019

Int J Cardiovasc Imaging

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HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

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Afterload Hypersensitivity in Patients With Left Bundle Branch Block

Abstract: Moderate elevation of arterial pressure caused marked reductions in LVEF and GLS in patients with LBBB. This reflects a cardiodepressive effect of elevated afterload in the dyssynchronous ventricle and was attributed to loss of septal function.

Cited by 42 publications

References 29 publications

Mechanism of Abnormal Septal Motion in Left Bundle Branch Block

Mechanism of Abnormal Septal Motion in Left Bundle Branch Block

Apresentação de Software para Pós-processamento de Curvas de Deformação Cardíaca: D-Station

Myocardial work is a predictor of exercise tolerance in patients with dilated cardiomyopathy and left ventricular dyssynchrony

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