Left ventricular scar impact on left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy

Ahmed, Walid; Samy, Wael; Tayeh, Osama; Behairy, Noha; Fattah, Alia Abd El

doi:10.1016/j.ijcard.2016.07.158

Cited by 12 publications

(9 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In an attempt to improve the selection process, a multitude of variables have been studied. Among these, myocardial scar, by cardiac magnetic resonance (CMR)11–14 or nuclear imaging,15–17 has shown great potential in identifying non-responders. Prior studies have used varied definition of ‘response’, and the response rate has differed when defined as 6 min hall walk distances and improvement in quality of life scores compared with more objective endpoints such as heart failure hospitalisations and death 18.…”

Section: Introductionmentioning

confidence: 99%

Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response

et al. 2019

View full text Add to dashboard Cite

ObjectiveDetermine the prognostic impact of scar quantification (scar %) by cardiac magnetic resonance (CMR) in predicting heart failure admission, death and left ventricular (LV) function improvement following cardiac resynchronisation therapy (CRT), after controlling for the presence of left bundle branch block (LBBB), QRS duration (QRSd) and LV lead tip location and polarity.MethodsConsecutive patients who underwent CMR between 2002 and 2014 followed by CRT were included. The primary endpoint was death or heart failure admission. The secondary endpoint was change in ejection fraction (EF) ≥3 months after CRT. Cox proportional hazards, linear regression models and change in the area under the receiver operating characteristic curve (AUC) were used.ResultsA total of 84 patients were included (63% male, 51% with ischaemic cardiomyopathy). After adjusting for clinical factors, presence of LBBB and QRSd and LV lead tip location and polarity, greater scar % remained associated with a higher risk for clinical events (HR=1.06; 95% CI 1.02 to 1.10; p<0.001) and a smaller improvement in EF (slope: −0.61%; 95% CI −0.93% to 0.29%; p<0.001). When adding scar % to QRSd and LBBB, there was significant improvement in predicting clinical events at 3 years (AUC increased to 0.831 from 0.638; p=0.027) and EF increase ≥10% (AUC 0.869 from 0.662; p=0.007).ConclusionScar quantification by CMR has an incremental value in predicting response to CRT, in terms of heart failure admission, death and EF improvement, independent of the presence of LBBB, QRSd, LV lead tip location and polarity.

show abstract

Section: Introductionmentioning

confidence: 99%

Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Abnormal contractility modifies the strain-derived pattern of LBBB [16]. Decreased contractility and scarring may predict a poor response to CRT regardless of the pathogenesis of cardiomyopathy [17,18]. Our innovative parameter indirectly assesses the contractility.…”

Section: Discussionmentioning

confidence: 99%

Regional Strain Pattern Index—A Novel Technique to Predict CRT Response

Orszulak

Filipecki

Wróbel

et al. 2021

IJERPH

View full text Add to dashboard Cite

Background: Cardiac resynchronization therapy (CRT) improves outcome in patients with heart failure (HF) however approximately 30% of patients still remain non-responsive. We propose a novel index—Regional Strain Pattern Index (RSPI)—to prospectively evaluate response to CRT. Methods: Echocardiography was performed in 49 patients with HF (66.5 ± 10 years, LVEF 24.9 ± 6.4%, QRS width 173.1 ± 19.1 ms) two times: before CRT implantation and 15 ± 7 months after. At baseline, dyssynchrony was assessed including RSPI and strain pattern. RSPI was calculated from all three apical views across 12 segments as the sum of dyssynchronous components. From every apical view, presence of four components were assessed: (1) contraction of the early-activated wall; (2) prestretching of the late activated wall; (3) contraction of the early-activated wall in the first 70% of the systolic ejection phase; (4) peak contraction of the late-activated wall after aortic valve closure. Each component scored 1 point, thus the maximum was 12 points. Results: Responders reached higher mean RSPI values than non-responders (5.86 ± 2.9 vs. 4.08 ± 2.4; p = 0.044). In logistic regression analysis value of RSPI ≥ 7 points was a predictor of favorable CRT effect (OR: 12; 95% CI = 1.33–108.17; p = 0.004). Conclusions: RSPI could be a valuable predictor of positive outcome in HF patients treated with CRT.

show abstract

“…In this group of patients, probability of extreme gain of LV function after restoration of LV synchrony seems lower due to underlying impairment of myocardium. In patients with ischemic cardiomyopathy, presence of scar, inactive part of LV, make unable to complete convalescence [ 28 ]. In patients with non-ischemic cardiomyopathy, the probability of CRT profits remains higher but we cannot rule out genetic conditioning which restrains absolute LV systolic function recovery.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular global longitudinal strain in predicting CRT response: one more J-shaped curve in medicine

et al. 2021

View full text Add to dashboard Cite

The aim of the study was: (1) to verify the hypothesis that left ventricular global longitudinal strain (LVGLS) may be of additive prognostic value in prediction CRT response and (2) to obtain such a LVGLS value that in the best optimal way enables to characterize potential CRT responders. Forty-nine HF patients (age 66.5 ± 10 years, LVEF 24.9 ± 6.4%, LBBB 71.4%, 57.1% ischemic aetiology of HF) underwent CRT implantation. Transthoracic echocardiography was performed prior to and 15 ± 7 months after CRT implantation. Speckle-tracking echocardiography was performed to assess longitudinal left ventricular function as LVGLS. The response to CRT was defined as a ≥ 15% reduction in the left ventricular end-systolic volume (∆LVESV). Thirty-six (73.5%) patients responded to CRT. There was no linear correlation between baseline LVGLS and ∆LVESV (r = 0.09; p = 0.56). The patients were divided according to the percentile of baseline LVGLS: above 80th percentile; between 80 and 40th percentile; below 40th percentile. Two peripheral groups (above 80th and below 40th percentile) formed “peripheral LVGLS” and the middle group was called “mid-range LVGLS”. The absolute LVGLS cutoff values were − 6.07% (40th percentile) and − 8.67% (80th percentile). For the group of 20 (40.8%) “mid-range LVGLS” patients mean ΔLVESV was 33.3 ± 16.9% while for “peripheral LVGLS” ΔLVESV was 16.2 ± 18.8% (p < 0.001). Among non-ischemic HF etiology, all “mid-range LVGLS” patients (100%) responded positively to CRT (in “peripheral LVGLS”—55% responders; p = 0.015). Baseline LVGLS may have a potential prognostic value in prediction CRT response with relationship of inverted J-shaped pattern. “Mid-range LVGLS” values should help to select CRT responders, especially in non-ischemic HF etiology patients.

show abstract

Left ventricular scar impact on left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy

Cited by 12 publications

References 29 publications

Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response

Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response

Regional Strain Pattern Index—A Novel Technique to Predict CRT Response

Left ventricular global longitudinal strain in predicting CRT response: one more J-shaped curve in medicine

Contact Info

Product

Resources

About