Echocardiographic evaluation of cardiac resynchronization therapy: Ready for routine clinical use?

Bax, Jeroen J.; Ansalone, Gerardo; Breithardt, O.A.

doi:10.1016/j.accreview.2004.10.029

Cited by 128 publications

(173 citation statements)

References 46 publications

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“…3 Dyssynchrony is diagnosed by placing sample volumes, or regions of interest (ROIs), in several ventricular segments and comparing the velocity tracings from these segments. Manual tracking of the ROIs needs to be performed to maintain the location of the ROI within the segment of interest as the heart moves.…”

Section: Discussionmentioning

confidence: 99%

“…2 Left ventricular mechanical dyssynchrony can be diagnosed using Doppler tissue imaging (DTI) of the myocardium. 3 Diagnosis of dyssynchrony with DTI requires two main postprocessing steps which have not been standardized. First, velocity-time curves are generated from myocardial segments by placing regions of interest (ROIs) within both the mid-ventricular and basal segments of the LV walls.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Region of Interest Tracking on the Diagnosis of Left Ventricular Dyssynchrony from Doppler Tissue Images

Fornwalt

Thomas

Bhasin

et al. 2008

Journal of the American Society of Echocardiography

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Background-Left ventricular dyssynchrony is often diagnosed by comparing velocity curves from Doppler tissue images (DTI) of 2 or more myocardial regions. Velocity curves are generated by placing sample volumes or "regions of interest" (ROIs) within the myocardium. ROIs need to be manually relocated to maintain a mid-myocardial location as the heart moves, but are frequently left in a stationary position. The error caused by use of a stationary ROI may affect the diagnosis of dyssynchrony, but this has not been quantified.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Region of Interest Tracking on the Diagnosis of Left Ventricular Dyssynchrony from Doppler Tissue Images

Fornwalt

Thomas

Bhasin

et al. 2008

Journal of the American Society of Echocardiography

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“…Two indexes of mitral anulus asynchrony were calculated: the difference between the longest and the shortest time to the peak and end of the S2 wave respectively, and standard deviation of the average time intervals of movement of mitral annulus. 16 All echocardiographic measurements were made by a single observer (PS).…”

Section: Echocardiographic Evaluationmentioning

confidence: 99%

Asynchronous Movement of Mitral Annulus: An Additional Mechanism of Ischaemic Mitral Regurgitation

Szymański¹,

Klisiewicz²,

Hoffmań³

2007

Clinical Cardiology

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SummaryIn-coordinate mitral annulus movement might participate in the pathogenesis of functional mitral regurgitation. We evaluated a relationship between indices of mitral annulus systolic asynchrony and mitral regurgitation in patients after myocardial infarction in order to determine independent determinants of effective regurgitant orifice (ERO) area in a multivariate regression model.Tissue Doppler echocardiographic studies and quantitative analysis of mitral regurgitation were performed in 40 patients (33 men, 7 women, mean age 60.1 ± 9.2 years) with a history of Q-wave myocardial infarction, with and without significant functional mitral regurgitation.A multivariate regression model showed that mitral annulus movement asynchrony index-difference between the longest and the shortest time from the R wave in the electrocardiogram to the cessation of systolic movement of the four aspects of mitral annulus, is an independent from ejection fraction, sphericity index, tenting, annulus diameter and infarct location, determinant of mitral regurgitation ERO area (r 2 change 0.72, p 0.01). The only other independent predictor of ERO area was mitral annulus diameter (r 2 change 0.79, p 0.01). Other variables were predictors of ERO only in univariate analyses: ejection fraction (r 2 change 0.59, p 0.01), tenting area (r 2 change 0.76, p 0.01) and sphericity index (r 2 change 0.75, p 0.01).In conclusion, mitral annulus asynchrony is an additional mechanism contributing to the development of functional mitral regurgitation. This suggests, that cardiac resynchronization might be considered, either as a first line intervention in patients with mitral regurgitation not considered for mitral surgery or as a supplementary measure, when results of surgery are suboptimal.

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“…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.…”

Section: Ventricular Dyssynchronymentioning

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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Echocardiographic evaluation of cardiac resynchronization therapy: Ready for routine clinical use?

Cited by 128 publications

References 46 publications

Effects of Region of Interest Tracking on the Diagnosis of Left Ventricular Dyssynchrony from Doppler Tissue Images

Effects of Region of Interest Tracking on the Diagnosis of Left Ventricular Dyssynchrony from Doppler Tissue Images

Asynchronous Movement of Mitral Annulus: An Additional Mechanism of Ischaemic Mitral Regurgitation

Avaliação ecocardiográfica da terapia de ressincronização cardíaca

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