Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment

Ansalone, Gerardo; Giannantoni, Paride; Ricci, Renato Pietro; Trambaiolo, Paolo; Laurenti, A.; Fedele, Francesco; Santini, Massimo

doi:10.1067/mhj.2001.117324

Cited by 139 publications

(79 citation statements)

References 15 publications

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“…This most delayed region is usually on the posterior or posterolateral basal wall, as demonstrated by endocardial voltage mapping 15,16,18 and myocardial velocity imaging. 19,131,132 LV stimulation at these sites improves acute contractile response, functional capacity, and possibly mortality compared with anterior sites. [133][134][135][136][137] LV stimulation at anterior sites may even worsen contractile response in some patients by exaggerating intraventricular dyssynchrony.…”

Section: Crt Responders and Nonrespondersmentioning

confidence: 99%

Ventricular Pump Function and Pacing

Sweeney

Prinzen

2008

Circ: Arrhythmia and Electrophysiology

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O ptimal cardiac pump function depends on ordered mechanical events that are orchestrated by electrical timing. This electromechanical coupling occurs at multiple anatomic levels: within atria, between atria and ventricles, between ventricles, and especially within the left ventricle (LV). Such disruptions to proper electrical timing result in disordered mechanical events (desynchronization, or "dyssynchrony"), can occur spontaneously or be induced in isolation or in various combinations at any level, and degrade cardiac pump function. These disruptions to normal mechanical ordering occur because of fixed or functional conduction blocks and can be generated by myocardial disease or can be induced by cardiac pacing. The adverse effects of disruption of proper electromechanical coupling at all levels with particular attention to the effects of ventricular conduction delay due to conventional (usually right ventricular apical, RVA) pacing and left bundle-branch block (LBBB) are discussed later. Subsequently, remedies for prevention or treatment are discussed along the same lines. Consequences of Uncoupling atVarious Levels Uncoupling at the Atrial LevelThe right atrium and left atrium are activated nearly simultaneously (within 50 to 80 ms) during sinus rhythm. Preferential sites of interatrial conduction exist at the posteriorsuperior interatrial septum (Bachmann's bundle region), fossa ovalis, and coronary sinus ostium. 1,2 Significant interatrial conduction delays (up to 200 ms or greater) can occur in myopathic atria. Similar conduction delays can be also be induced, or exacerbated, by right atrial pacing. Delayed left atrial contraction can disrupt optimal left-sided atrioventricular (AV) coupling. Severe atrial decoupling and delayed left atrial contraction reverses the left-sided AV contraction sequence, resulting in atrial transport block. 3 This causes increased left atrial pressures, retrograde flow in the pulmonary veins, and counterphysiological neurohormonal responses termed "pseudopacemaker syndrome." 4 -6 Uncoupling at Atrioventricular LevelOptimal AV coupling contributes to ventricular pump function. The normal AV interval results in atrial contraction just before the pre-ejection (isovolumic) period of ventricular contraction that maximizes LV filling (LV end-diastolic pressure, or preload) and cardiac output by the Starling mechanism. This optimal timing relationship maximizes diastolic filling time, reduces diastolic mitral regurgitation (MR), and maintains mean left atrium pressure at low levels. Delayed AV coupling due to conduction delay in the AV node displaces atrial contraction earlier in diastole, which may occur immediately after or even within the preceding ventricular contraction. Atrial contraction before completion of venous return reduces preload and contractile force. A late diastolic LVϾleft atrium pressure gradient may occur, causing diastolic MR and partial closure of the mitral valve, which shortens diastolic filling time. Delayed AV coupling may be worsened or induced by atrial...

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Section: Crt Responders and Nonrespondersmentioning

confidence: 99%

Ventricular Pump Function and Pacing

Sweeney

Prinzen

2008

Circ: Arrhythmia and Electrophysiology

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“…5 Studies also observed that volumetric responders were associated with clinical improvements. 5,11 The technique of TDI was also combined with SRI to search for PSS, or delayed longitudinal contraction. 10,23 The presence of PSS in the basal LV segments was found to correlate with the gain in ejection fraction in 25 patients receiving CRT.…”

Section: Tdi Pss Sri and Reverse Remodelingmentioning

confidence: 99%

Tissue doppler imaging is superior to strain rate imaging and postsystolic shortening in the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy

Yu¹,

Fung²,

Zhang³

2004

ACC Current Journal Review

168

291

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Background-A number of noninvasive techniques have been used to predict the effectiveness of cardiac resynchronization therapy (CRT) in heart failure patients, in particular left ventricular (LV) reverse remodeling. This study compared the relative predictive values of tissue Doppler imaging (TDI) and strain-rate imaging (SRI) parameters for LV reverse remodeling in patients who received CRT and examined for potential differences in ischemic (nϭ22) and nonischemic (nϭ32) heart failure. Methods and Results-TDI and SRI were performed at baseline and 3-month follow-up. Eighteen parameters of intraventricular and interventricular asynchrony based on the time to peak myocardial contraction (Ts) and time to peak strain rate (Tsr) were compared, along with postsystolic shortening (PSS). Reverse remodeling with reduction of LV end-diastolic and end-systolic volumes and gain in ejection fraction (all PϽ0.001) was observed in the whole study population. The standard deviation of Ts of 12 LV segments (Ts-SD) is the most powerful predictor of reverse remodeling in both the ischemic (rϭϪ0.65, PϽ0.001) and nonischemic (rϭϪ0.79, PϽ0.001) groups. The PSS of 12 LV segments was a good predictor only for the nonischemic (rϭϪ0.64, PϽ0.001) but not the ischemic (rϭ0.32, PϭNS) group. However, parameters of SRI and interventricular asynchrony failed to predict reverse remodeling. By multiple regression analysis, independent parameters included Ts-SD in both groups (PϽ0.005) and PSS of 12 LV segments in the nonischemic group (Pϭ0.03). The area of the receiver operating characteristic curve was largest for Ts-SD (0.94; CIϭ0.88 to 1.00). Conclusions-Ts-SD is the most powerful predictor of LV reverse remodeling and was consistently useful for ischemic and nonischemic heart failure. However, PSS is useful only for nonischemic pathogenesis, whereas the role of SRI parameters was not supported by the present study.

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“…Tissue Doppler imaging (TDI) has been used to measure myocardial contraction and relaxation velocities, and to identify the presence of mechanical delays in dyssynchrony patients (12)(13)(14)(15). TDI measurements such as septal-to-posterior wall motion delay, time to peak systolic velocity, and the standard deviation (SD) of the time to peak velocity across the LV may predict clinical and echocardiographic response to CRT (13).…”

mentioning

confidence: 99%

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

Delfino

Bhasin

Cole

et al. 2006

Magnetic Resonance Imaging

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Purpose: To compare longitudinal myocardial velocity and time to peak longitudinal velocity obtained with magnetic resonance phase velocity mapping (MR-PVM) and tissue Doppler imaging (TDI), and to assess the reproducibility of each method. Materials and Methods:Longitudinal myocardial velocity was measured by TDI and MR-PVM in 10 normal volunteers and 10 patients with dyssynchrony. The reproducibility of MR-PVM and TDI was assessed on repeated measurements in the 10 normal volunteers.Results: MR and TDI measurements of longitudinal myocardial velocity correlated well (r ϭ 0.86) in both normal subjects and patients with dyssynchrony. However, myocardial velocities measured with MR consistently exceeded velocities measured with TDI. MR and TDI agreed strongly in measuring the time to peak velocity (r ϭ 0.97). The reproducibility of TDI and MR-PVM appeared similar in measuring peak velocities (13.1% vs. 11.0%, respectively; P ϭ NS) and time to peak velocity (9.1% vs. 5.7%, respectively; P ϭ NS). Conclusion:Excellent correlation and reproducibility were observed between MR-PVM and TDI in measuring longitudinal myocardial velocity and time to peak velocity in both normal subjects and patients with dyssynchrony.

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Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment

Cited by 139 publications

References 15 publications

Ventricular Pump Function and Pacing

Ventricular Pump Function and Pacing

Tissue doppler imaging is superior to strain rate imaging and postsystolic shortening in the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

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