Electrical remodeling reflected by QRS and T vector changes following cardiac resynchronization therapy is related to survival in heart failure patients with left bundle branch block

Floré, Vincent; Bartúnek, Jozef; Goethals, Marc; Verstreken, Sofie; Timmermans, W.; Pauw, F. De; Bockstal, Koen Van; Vanderheyden, Marc

doi:10.1016/j.jelectrocard.2015.02.004

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…A large baseline T‐wave area strengthened the prediction of a good clinical outcome during 3 years of follow‐up in a CRT patient cohort with LBBB morphology 33 . Electrical remodeling following CRT, reflected by changes in QRS and T vectors, was associated with significantly better survival in patients with LBBB 34 . Whether the normalization of repolarization heterogeneity is associated with improved LVEF in HF therapy represents another important issue.…”

Section: Discussionmentioning

confidence: 99%

Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block

Chien

Chang

Lin

et al. 2020

Cardiovasc electrophysiol

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Introduction This study aimed to investigate the association between T‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT). Methods and Results We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were reconstructed from digital standard 12‐lead electrocardiograms by T‐wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end‐systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF < 40%. Among 40 patients who underwent CRT, those with a larger TMD (P = .007), larger PL (P = .025), and more negative TCRT (P = .015) had better response to CRT. A large TMD (P = .018) and large PL (P = .003) were also independent predictors of the clinical outcome endpoint. Conclusions Increases in repolarization heterogeneity in patients with cLBBB are associated with impaired LVEF. A large TMD and large PL may be useful as additional predictors of response to CRT, improving patient selection for CRT.

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Section: Discussionmentioning

confidence: 99%

Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block

Chien

Chang

Lin

et al. 2020

Cardiovasc electrophysiol

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“…Huang et al demonstrated that HF patients with LBBB, larger T-wave morphology dispersion, larger T wave loop area, and more negative QRS-to-T angle had a better echocardiographic response to CRT [19]. Flore et al found that the absence of any changes in QRS duration and broader electrical remodeling (including the measurements of the angles between spatial QRS and T vectors before, during, and after CRT) are associated with notably better survival rates [23].…”

Section: Discussionmentioning

confidence: 99%

Use of T-wave duration and Tpeak-Tend interval as new prognostic markers for patients treated with cardiac resynchronization therapy

Usalp¹,

Gündüz²

2021

Kardiol Pol

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“…Improvements are quite variable with up to 30% of patients being non-responders to this treatment at all[ 2 , 5 ]. Nevertheless, the efficacy and optimization of CRT continues to being improved[ 6 , 7 ]. For example, it has been shown that extensive electrical remodeling is significantly associated with better survival rates after CRT[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the efficacy and optimization of CRT continues to being improved[ 6 , 7 ]. For example, it has been shown that extensive electrical remodeling is significantly associated with better survival rates after CRT[ 6 ]. Other measurements than electrical dyssynchrony have been investigated as identifications for CRT implantation estimation.…”

Section: Introductionmentioning

confidence: 99%

Implementation of Contraction to Electrophysiological Ventricular Myocyte Models, and Their Quantitative Characterization via Post-Extrasystolic Potentiation

Gray

Fenton

2015

PLoS ONE

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Heart failure (HF) affects over 5 million Americans and is characterized by impairment of cellular cardiac contractile function resulting in reduced ejection fraction in patients. Electrical stimulation such as cardiac resynchronization therapy (CRT) and cardiac contractility modulation (CCM) have shown some success in treating patients with HF. Computer simulations have the potential to help improve such therapy (e.g. suggest optimal lead placement) as well as provide insight into the underlying mechanisms which could be beneficial. However, these myocyte models require a quantitatively accurate excitation-contraction coupling such that the electrical and contraction predictions are correct. While currently there are close to a hundred models describing the detailed electrophysiology of cardiac cells, the majority of cell models do not include the equations to reproduce contractile force or they have been added ad hoc. Here we present a systematic methodology to couple first generation contraction models into electrophysiological models via intracellular calcium and then compare the resulting model predictions to experimental data. This is done by using a post-extrasystolic pacing protocol, which captures essential dynamics of contractile forces. We found that modeling the dynamic intracellular calcium buffers is necessary in order to reproduce the experimental data. Furthermore, we demonstrate that in models the mechanism of the post-extrasystolic potentiation is highly dependent on the calcium released from the Sarcoplasmic Reticulum. Overall this study provides new insights into both specific and general determinants of cellular contractile force and provides a framework for incorporating contraction into electrophysiological models, both of which will be necessary to develop reliable simulations to optimize electrical therapies for HF.

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Electrical remodeling reflected by QRS and T vector changes following cardiac resynchronization therapy is related to survival in heart failure patients with left bundle branch block

Cited by 5 publications

References 27 publications

Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block

Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block

Use of T-wave duration and Tpeak-Tend interval as new prognostic markers for patients treated with cardiac resynchronization therapy

Implementation of Contraction to Electrophysiological Ventricular Myocyte Models, and Their Quantitative Characterization via Post-Extrasystolic Potentiation

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