Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and nonresponders to cardiac resynchronization therapy

Chen, Zhong; Hanson, Ben; Sohal, Manav; Sammut, Eva; Jackson, Tom; Child, Nicholas; Claridge, Simon; Behar, Jonathan M.; Niederer, S; Gill, Jaswinder; Carr‐White, Gerald; Razavi, Reza; Rinaldi, Christopher Aldo; Taggart, Peter

doi:10.1016/j.hrthm.2016.06.014

Cited by 7 publications

(14 citation statements)

References 35 publications

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“…These clinical studies support mechanistic (Chen et al, 2016(Chen et al, , 2013 and theoretical (Kuijpers et al, 2014) investigations that suggest that MEF is likely to be relevant in heart failure. Further investigation is required to elucidate these mechanisms.…”

Section: Dyssynchronous Heart Failuresupporting

confidence: 74%

“…Local LV APD decreases in heart failure patients that respond to CRT with more than 15% reduction in LV end-systolic volume after 6 months, while it increased in non-responders (Chen et al, 2013). Furthermore, a nonlinear relation between changes in local LV repolarization and strain has been found, where the decrease in APD was associated with local decrease in time-to-peak radial, circumferential, and longitudinal strains (Chen et al, 2016). These results are consistent with other studies where electrophysiological changes during CRT were assessed through surface electrocardiographic analysis (Lellouche et al, 2011).…”

Section: Chronic Stretchmentioning

confidence: 96%

“…The use of new multi-parametric epicardial socks integrating sensors for electrical and functional measurements may also be beneficial in future studies (Xu et al, 2014). CRT devices offer the possibility of assessing electro-mechanical remodelling by relating regional strain to changes in local repolarization via the leads (Chen et al, 2016(Chen et al, , 2013, and may be used to further investigate electro-mechanical remodelling. Electro-anatomical mapping systems can provide a detailed assessment of electro-mechanical coupling during electrophysiological studies (Gyöngyösi and Dib, 2011;Kroon et al, 2015;Ravelli et al, 2011) and they may play an important role in future human studies.…”

Section: Open Questions and Direction For Future Studiesmentioning

confidence: 99%

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Mechano-electrical feedback in the clinical setting: Current perspectives

Orini

Nanda

Yates

et al. 2017

Progress in Biophysics and Molecular Biology

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Mechano-electric feedback (MEF) is an established mechanism whereby myocardial deformation causes changes in cardiac electrophysiological parameters. Extensive animal, laboratory and theoretical investigation has demonstrated that abnormal patterns of cardiac strain can induce alteration of electrical excitation and recovery through MEF, which can potentially contribute to the establishment of dangerous arrhythmias. However, the clinical relevance of MEF in patients with heart disease remains to be established. This paper reviews up-to date experimental evidence describing the response to different types of mechanical stimuli in the intact human heart with the support of new data collected during cardiac surgery. It discusses modulatory effects of MEF that may contribute to increase the vulnerability to arrhythmia and describes MEF interaction with clinical conditions where mechanically induced changes in cardiac electrophysiology are likely to be more relevant. Finally, directions for future studies, including the need for in-vivo human data providing simultaneous assessment of the distribution of structural, functional and electrophysiological parameters at the regional level, are identified.

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Section: Dyssynchronous Heart Failuresupporting

confidence: 74%

Section: Chronic Stretchmentioning

confidence: 96%

Section: Open Questions and Direction For Future Studiesmentioning

confidence: 99%

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Mechano-electrical feedback in the clinical setting: Current perspectives

Orini

Nanda

Yates

et al. 2017

Progress in Biophysics and Molecular Biology

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“…18 A 30 second recording of LV UEG was made using the device programmer at a sampling frequency of 512 Hz and extracted for off-line analysis. 19,20…”

Section: Study Population and Data Acquisitionmentioning

confidence: 99%

“…Shortening of basic APD occurs in responders to CRT, whilst lengthening of basic APD occurs in non-responders. 20 In vivo electrical remodelling in heart failure at the level of BBV-APD needs to be studied prospectively and may offer insight into the impact of CRT on…”

Section: Relation To Prior Work On Basic Apd and Qt Interval Measuremmentioning

confidence: 99%

Left ventricular activation-recovery interval variability predicts spontaneous ventricular tachyarrhythmia in patients with heart failure

et al. 2019

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Background: Enhanced beat-to-beat variability of repolarization (BVR) is strongly linked to arrhythmogenesis and is largely due to variation in ventricular action potential duration (APD). Previous studies in humans have relied on QT interval measurements; however, a direct relationship between beat-to-beat variability of APD and arrhythmogenesis in humans has yet to be demonstrated. Objectives: This study aimed to explore the beat-to-beat repolarization dynamics within a heart failure population at the level of ventricular APD. Methods: 43 patients with heart failure and implanted cardiac resynchronization therapy defibrillator devices were studied. Activation-recovery intervals (ARI) as a surrogate for APD were recorded from the left ventricular epicardial lead while pacing from the right ventricular lead to maintain constant cycle length. Results: During mean follow-up of 23.6±13.6 months, 11 patients sustained VT/VF and received appropriate implantable cardioverter-defibrillator therapies (Anti-Tachycardia Pacing or shock therapy). ARI variability (ARIV) was significantly greater in patients with subsequent VT/VF vs. those without VT/VF (3.55±1.3 ms vs. 2.77±1.09 ms, p=0.047). Receiver operating characteristic curve analysis (AUC 0.71, p=0.046) suggested high and low risk ARIV groups for VT/VF. The Kaplan-Meier survival analysis demonstrated that the time until first appropriate therapy for VT/VF was significantly shorter in the high-risk ARIV group (p=0.028).

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Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

Falcão‐Pires,

Ferreira,

Trindade

et al. 2024

European J of Heart Fail

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Cardiovascular disease (CVD) is the leading cause of morbimortality in Europe and worldwide. CVD imposes a heterogeneous spectrum of cardiac remodelling, depending on the insult nature, that is, pressure or volume overload, ischaemia, arrhythmias, infection, pathogenic gene variant, or cardiotoxicity. Moreover, the progression of CVD‐induced remodelling is influenced by sex, age, genetic background and comorbidities, impacting patients' outcomes and prognosis. Cardiac reverse remodelling (RR) is defined as any normative improvement in cardiac geometry and function, driven by therapeutic interventions and rarely occurring spontaneously. While RR is the outcome desired for most CVD treatments, they often only slow/halt its progression or modify risk factors, calling for novel and more timely RR approaches. Interventions triggering RR depend on the myocardial insult and include drugs (renin–angiotensin–aldosterone system inhibitors, beta‐blockers, diuretics and sodium–glucose cotransporter 2 inhibitors), devices (cardiac resynchronization therapy, ventricular assist devices), surgeries (valve replacement, coronary artery bypass graft), or physiological responses (deconditioning, postpartum). Subsequently, cardiac RR is inferred from the degree of normalization of left ventricular mass, ejection fraction and end‐diastolic/end‐systolic volumes, whose extent often correlates with patients' prognosis. However, strategies aimed at achieving sustained cardiac improvement, predictive models assessing the extent of RR, or even clinical endpoints that allow for distinguishing complete from incomplete RR or adverse remodelling objectively, remain limited and controversial. This scientific statement aims to define RR, clarify its underlying (patho)physiologic mechanisms and address (non)pharmacological options and promising strategies to promote RR, focusing on the left heart. We highlight the predictors of the extent of RR and review the prognostic significance/impact of incomplete RR/adverse remodelling. Lastly, we present an overview of RR animal models and potential future strategies under pre‐clinical evaluation.

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Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and nonresponders to cardiac resynchronization therapy

Cited by 7 publications

References 35 publications

Mechano-electrical feedback in the clinical setting: Current perspectives

Mechano-electrical feedback in the clinical setting: Current perspectives

Left ventricular activation-recovery interval variability predicts spontaneous ventricular tachyarrhythmia in patients with heart failure

Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

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