Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony

Pitzalis, Maria Vittoria; Iacoviello, Massimo; Romito, Roberta; Massari, Francesco; Rizzon, Brian; Luzzi, Giovanni; Guida, Pietro; Andriani, A; Mastropasqua, Filippo; Rizzon, Paolo

doi:10.1016/s0735-1097(02)02337-9

Cited by 628 publications

(287 citation statements)

References 24 publications

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“…Although 15% reductions in LV systolic volume have been evaluated in previous studies assessing echocardiographic predictors [6, 21], we used 10% reductions in LV ESV as a definition of response to CRT for the following reasons: the ideal end point to assess response to CRT is currently unclear [12], discrepancy exists between clinical and echocardiographic end points, with greater rate of clinical response compared with echocardiographic response [22], and 10% reductions in LV ESV have been shown to be a strong predictor of lower long-term mortality and heart failure events [18]. …”

Section: Discussionmentioning

confidence: 99%

Visual Assessment of Left Ventricular Dyssynchrony Using Tissue Synchronization Imaging

et al. 2009

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Background: Tissue synchronizing imaging (TSI) allows visual detection of asynchronous myocardial contraction. Although it is a screening tool for the detection of left ventricular (LV) dyssynchrony, its use as a qualitative method to assess dyssynchrony has not been studied. We evaluated the correlation of the visual assessment of dyssynchrony using TSI with quantitative assessment, the value of visual assessment to predict reverse remodeling to cardiac resynchronization therapy (CRT). Methods: Echocardiograms from 100 consecutive patients were retrospectively evaluated. We compared visual TSI assessment with the qualitative assessment of dyssynchrony obtained by tissue Doppler imaging (TDI). The utility of visual assessment as a predictor of response to CRT was evaluated in 43 patients. Results: In 86% of the cases, visual assessment was possible, and reproducibility was unrelated to observer experience. Each grade of visual dyssynchrony corresponded to a range of values of time to peak velocity (TPV) gradient (p < 0.001). Grade ≥1 dyssynchrony by visual assessment had 90% sensitivity and 95% specificity to identify ≥65 ms TPV gradient of LV opposing walls, and 93% sensitivity and 70% specificity to predict reverse LV remodeling. Conclusion: LV dyssynchrony may be visually assessed by TSI, which can also predict reverse LV remodeling.

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Section: Discussionmentioning

confidence: 99%

Visual Assessment of Left Ventricular Dyssynchrony Using Tissue Synchronization Imaging

et al. 2009

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“…Septal to posterior wall delay was calculated as the time difference between the onset of the QRS to that of the peak of deformation of the inter‐ventricular septum and the left ventricular posterior. Although extent of dyssynchrony was analysed as a continuum, septal to posterior wall delay of 130 ms or more was considered diagnostic of clinically significant of intraventricular mechanical dyssynchrony 13. Left ventricular volumes including end‐diastolic, end‐systolic, and stroke volumes were measured in two dimensions and ejection fraction calculated by the modified Simpson's method in biplane using 2D images.…”

Section: Methodsmentioning

confidence: 99%

Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

et al. 2017

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AimsTo evaluate whether peripheral circulatory ‘remodelling’ as measured by changes in vascular compliance and in markers of nitric oxide signalling contributes to patient response to cardiac resynchronization therapy (CRT).Methods and resultsEffects of CRT were evaluated in 33 patients pre‐procedure and 6 months post‐procedure. Peak oxygen consumption, 6 min walk distance, New York Heart Association class, and quality of life score were evaluated. Augmentation index and its interactions with nitric oxide (NO) were evaluated by applanation tonometry. Platelet NO responsiveness and content of thioredoxin‐interacting protein were assessed. Plasma concentrations of N‐terminal proBNP, asymmetric and symmetric dimethylarginine (SDMA), high sensitivity C‐reactive protein, catecholamines, and matrix metalloproteinases‐2 and ‐9 were assessed. Despite significant improvement in 6 min walk distance (P = 0.005), New York Heart Association class (P < 0.001), quality of life (P = 0.001), and all echocardiographic parameters post‐CRT, there were no significant changes in augmentation index measurements, thioredoxin‐interacting protein content, and platelet NO response. Significant falls in N‐terminal proBNP (P = 0.008) and SDMA (P = 0.013; independent of renal function) occurred. Falls in SDMA predicted reduction in high‐sensitivity C‐reactive protein (P = 0.04) and increases in peak oxygen consumption (P = 0.04). There were no correlations between changes in echocardiographic parameters and those in vascular function.ConclusionsThese data suggest that the beneficial effects of CRT over 6 months are independent of any change in peripheral NO‐related signalling. However, there is evidence that suppression of inflammation occurs, and its magnitude predicts extent of clinical improvement.

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“…The simplest method for evaluating dyssynchrony is M‐mode analysis of posterior wall to septal delay with = 130 ms predicting HF improvement with CRT 69 . Pulsed‐wave TDI is performed on line and generally considered more difficult and time‐consuming.…”

Section: Newer Parameters and Applicationmentioning

confidence: 99%

Echocardiographic evaluation of systolic heart failure

Thomas

2009

Australas J Ultrason Med

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Echocardiography is the most commonly used modality for evaluating left ventricular size and function in the context of systolic heart failure. Traditional techniques, though extensively used, have their limitations and more recently several newer technologies have emerged that are more reproducible, provide prognostic information, guide therapies and have an important role in monitoring progress. This review will evaluate the traditional and more novel techniques used and briefly provide an overview of the role of echocardiography in guiding and monitoring therapies in patients with systolic heart failure.

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Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony

Abstract: In patients with advanced heart failure and LBBB, baseline SPWMD is a strong predictor of the occurrence of reverse remodeling after CRT, thus suggesting its usefulness in identifying patients likely to benefit from biventricular pacing.

Cited by 628 publications

References 24 publications

Visual Assessment of Left Ventricular Dyssynchrony Using Tissue Synchronization Imaging

Visual Assessment of Left Ventricular Dyssynchrony Using Tissue Synchronization Imaging

Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

Echocardiographic evaluation of systolic heart failure

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