Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing

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

doi:10.1016/s0735-1097(01)01772-7

Cited by 437 publications

(174 citation statements)

References 13 publications

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“…In a retrospective analysis where TDI assessment of mechanical activation was performed prior to CRT implantation, patients in whom the LV lead was situated at the site exhibiting the latest activation showed increased functional and echocardiographic improvements [15]. Superior response to CRT was also observed when the site of LMA was targeted using tissue synchronization imaging (TSI) [90], 3D echocardiography [91], and speckle tracking [92].…”

Section: Dyssynchrony Assessment and Identification Of The Site Of Lamentioning

confidence: 99%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.Areas covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.Expert commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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Section: Dyssynchrony Assessment and Identification Of The Site Of Lamentioning

confidence: 99%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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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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“…This site is in the lateral wall in 35% of the cases, in the anterior and posterior walls in 26% and 23%, respectively, and rarely in the inferior and septal walls (16%) 29 .…”

Section: Where Should the Electrode Be Implanted?mentioning

confidence: 97%

“…And, in fact, Ansalone et al 29 have demonstrated that the best result was obtained in patients whose electrodes were implanted according to the site with the greatest electromechanical delay, determined on echocardiography.…”

Section: Lateral Wall Systolic Peakmentioning

confidence: 99%

Avaliação ecocardiográfica da terapia de ressincronização cardíaca

Silva¹,

Barretto²

2005

Arq. Bras. Cardiol.

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Heart failure is one of the major causes of mortality, morbidity, and hospitalization in patients older than 60 years, accounting for 1 to 2% of the total expenditure in the health sector in the United States (approximately 20 billion dollars per year!) 1,2 . Despite the great advances in therapy, the morbidity and mortality rates still remain high 3 . Cardiac resynchronization therapy (CRT) was introduced in the beginning of the 1990's and rapidly developed until its approval in 2001 by the FDA (Food and Drugs Administration) 4 .In the American Heart Association guidelines, CRT has been considered to be IIA evidence level 5 . Those guidelines were based on 2 large trials: the MUSTIC 6 and the MIRACLE 7 . In both, the inclusion criteria were similar: a) significant heart failure despite appropriate therapy; b) low ejection fraction; and c) broad QRS with left bundle-branch block pattern (duration>120 ms). Both studies have confirmed that CRT significantly improves symptoms, tolerance to exercise, and quality of life. Nevertheless, 20% to 30% of the patients do not improve with CRT 8 , emphasizing the need for new criteria of patients' selection.Recent studies have reported that mechanical dyssynchrony is not always related to electrical dyssynchrony 9,10 , and that the presence of ventricular dyssynchrony is the best predictor of a good response to resynchronization therapy. In reality, some patients with broad QRS may not have mechanical dyssynchrony while others with narrow QRS may [11][12][13] .Although QRS duration is a good prognostic marker for mortality in patients with heart failure and is present in more than 80% of the individuals in the 2 months preceding death 14,15 , studies comparing QRS alterations with the clinical outcome of patients seem to show little or no relation to prognosis 16 .These data suggest that electrocardiography may not be the best complementary diagnostic method for selecting candidates to CRT. Other imaging techniques, particularly the new methods for assessing ventricular function on echocardiography, seem to be better for selecting patients who will best respond to resynchronization therapy.Both the presence of broad QRS and the signs of interventricular dyssynchrony are predictors of hospitalization and severe cardiac events in patients with heart failure 17,18 . Ventricular dyssynchronyThe mechanism of dyssynchrony includes regional delays of both ventricular contraction and relaxation. The right ventricle contracts during left ventricular telediastole leading to a septal bulging towards the left ventricle. In addition, the delay in the activation of the papillary muscles causes, or worsens, mitral incompetence 19 . All such factors contribute to a reduction in the ejection fraction and a worsening of the clinical symptoms.Dyssynchrony may be inter-or intraventricular, and echocardiography may evaluate both types through several techniques.One way of evaluating interventricular dyssynchrony is by measuring the time between ventricular ejections. Conventional Doppler measure...

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Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing

Abstract: After BIV, LV performance improved significantly in all patients; however, the greatest improvement was found in patients paced at the most delayed site.

Cited by 437 publications

References 13 publications

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Optimal site selection and image fusion guidance technology to facilitate 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

Avaliação ecocardiográfica da terapia de ressincronização cardíaca

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