Left ventricular systolic asynchrony after acute myocardial infarction in patients with narrow QRS complexes

Zhang, Yan; Chan, Anna; Yu, Cheuk‐Man; Lam, Wynnie W. M.; Yip, Gabriel Wai-Kwok; Fung, Winston Wing‐Shing; So, N. M. C.; Wang, Mei; Sanderson, John E.

doi:10.1016/j.ahj.2004.05.054

Cited by 73 publications

(68 citation statements)

References 27 publications

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“…Although asynchronous motion is often apparent in patients with myocardial infarction (MI) and has been associated with infarct size 8 and left ventricular remodeling at 6 months, 9 the relationship between ventricular synchrony and prognosis after MI remains unclear. We used data from the Valsartan in Acute Myocardial Infarction (VALIANT) study to test the hypothesis that left ventricular dyssynchrony would affect clinical outcome after acute MI.…”

Section: Clinical Perspective On P 1103mentioning

confidence: 99%

Mechanical Dyssynchrony After Myocardial Infarction in Patients With Left Ventricular Dysfunction, Heart Failure, or Both

et al. 2010

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Background-Mechanical dyssynchrony is considered an independent predictor for adverse cardiovascular outcomes in patients with heart failure. However, its importance as a risk factor after myocardial infarction is not well defined. Methods and Results-We examined the influence of mechanical dyssynchrony on outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction who were enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) echocardiography study. B-mode speckle tracking with velocity vector imaging was used to assess ventricular synchrony in 381 patients who had image quality sufficient for analysis. Time to regional peak velocity and time to strain rate were measured among 12 left ventricular segments from the apical 4-and 2-chamber views, and the SDs between all 12 segments were used as a measure of dyssynchrony. The relationships between the SD of time to regional peak velocity and strain rate and clinical outcome of death or heart failure were assessed. In a multivariate Cox model adjusted for clinical and echocardiographic variables, the SD of time to peak velocity (hazard ratio per 10 ms, 1.10; 95% confidence interval, 1.02 to 1.18; Pϭ0.010) and the SD of time to strain rate (hazard ratio per 10 ms, 1.16; 95% confidence interval, 1.06 to 1.27; Pϭ0.001) were independent predictors of death or heart failure. Conclusion-Left ventricular dyssynchrony is independently associated with increased risk of death or heart failure after myocardial infarction, suggesting that contractile pattern may play a role in post-myocardial infarction prognosis.

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Section: Clinical Perspective On P 1103mentioning

confidence: 99%

Mechanical Dyssynchrony After Myocardial Infarction in Patients With Left Ventricular Dysfunction, Heart Failure, or Both

et al. 2010

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“…This normal synchronization is dependent on a normal conduction system, stimulation-contraction, myocardial structure, and heart function (12). A similar relation between heart failure and myocardial synchronization has been shown in cardiac diseases such as acute myocardial infarction (2)(3)(4)13), unstable angina pectoris (14,15) and hypertrophic cardiomyopathy (16). The studies that demonstrate the effect of percutaneous coronary intervention on myocardial synchrony in acute myocardial infarction are limited in number.…”

Section: Introductionmentioning

confidence: 68%

“…Manka et al (44) demonstrated that the regression of left ventricular dyssynchrony during healing of acute AMI. Zhang et al (2) analyzed left ventricular systolic dyssynchrony in acute myocardial infarction patients with normal QRS durations. A total of 47 ST-segment elevation myocardial infarction patients were enrolled in the study and compared to the control group.…”

Section: Discussionmentioning

confidence: 99%

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Acute effect of primary percutaneous coronary intervention on left ventricular dyssynchrony in ST-segment elevation myocardial infarction

İnci¹,

Karakelleoğlu²,

Taş³

et al. 2014

Anadolu Kardiyol Derg

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Objective: The aim of this study was to prospectively evaluate the effect of percutaneous coronary intervention in the acute period on left ventricular dyssynchrony in ST-segment elevation myocardial infarction patients by using Tissue Synchronization Imaging. Methods: Forty-four ST-segment elevation myocardial infarction (MI) patients (29 male, 15 female), who were admitted within the first 12 hours of chest pain symptoms, were enrolled in the study. According to the localization of MI, the patients were divided into groups as anterior MI (n=26) and inferior MI (n=18). All echocardiography measurements were taken just before percutaneous coronary intervention (PCI) and following PCI at a mean of 3-6 days. They were assessed according to the time to reach the peak systolic velocity, which was calculated by the tissue synchronization imaging method from four pairs of non-apical alternate segments. The difference between the duration to reach the peak systolic velocity in alternate segments was regarded as left ventricle dyssynchrony and the results were compared. Results: In the anterior MI group, basal anterior (p<0.01), mid-anterior segment (p<0.01) and basal septal segment (p<0.01); in the inferior MI group, the basal septal segment (p=0.02), mid-septal segment (p=0.02), and basal and mid-inferior segment (p<0.01) values were significantly lower in the post-PCI measurements when compared to the measurements taken prior to PCI. In both groups, the intraventricular dyssynchrony indices of the basal anterior-basal inferior (p<0.01), mid-anterior-mid-inferior (p<0.01) segments were found to be significantly lower in the post-PCI period when compared to the pre-PCI period. Conclusion: It was found that percutaneous coronary intervention in patients with ST-elevation significantly decreases the degree of LV dyssynchrony in the acute period. (Anadolu Kardiyol Derg 2014; 14: 591-8)

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“…The extent of myocardial scar tissue has been associated with LV dyssynchrony in patients with acute myocardial infarction 68 ; however, in heart failure patients, this association remains unclear, because patients with nonischemic cardiomyopathy and without myocardial scar may also show LV mechanical dyssynchrony. Myocardial scar tissue may influence CRT response through different pathophysiological pathways.…”

Section: Prediction Of Response To Crt: Beyond LV Dyssynchronymentioning

confidence: 99%

Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Clinically Useful

Delgado

Bax

2011

Circulation

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T he beneficial effects of cardiac resynchronization therapy (CRT) on morbidity and mortality of heart failure patients with wide QRS complex have been demonstrated extensively. Various single-center and multicenter randomized, clinical trials have shown that CRT improves heart failure symptoms and left ventricular (LV) function and induces a significant reduction in LV volumes and mitral regurgitation. [1][2][3][4] In addition, CRT reduces the number of heart failure hospitalizations and improves long-term survival. [5][6][7][8] More important, unlike other heart failure medical therapies that may lose their effects over time, CRT is a long-term effective therapy. 9 Accordingly, current American Heart Association/American College of Cardiology/Heart and Rhythm Society guidelines consider CRT a class I indication for patients with drug-refractory heart failure symptoms, LV ejection fraction Ͻ35%, and wide QRS complex (Ͼ120 ms). 10 Response by Sung and Foster on p 655Despite these encouraging results, cumulative evidence shows that only 60% to 80% of patients exhibit a favorable clinical or echocardiographic response to CRT. 1 For example, in the MIRACLE (Multicenter InSync Randomized Clinical Evaluation) and the MIRACLE-ICD (Multicenter InSync Implantable Cardioverter Defibrillator) trials, more than 30% of the patients fulfilling the aforementioned inclusion criteria did not show a favorable clinical response to CRT. 5,8 Several single-center studies have reported similar nonresponse rates and have questioned the accuracy of these inclusion criteria to identify patients who will respond to CRT, which has encouraged the research of novel indices and strategies that can reliably predict response to CRT.One of these indices is LV mechanical dyssynchrony. In the last decade, multiple single-center trials and the Cardiac Resynchronization in Heart Failure (CARE-HF) trial have demonstrated that LV mechanical dyssynchrony indices (most of which are based on echocardiographic measures) have superior accuracy compared with LV electric dyssynchrony (based on QRS duration) to predict response to CRT and long-term outcome. 7,11-13 However, those results were challenged recently by the multicenter PROSPECT (Predictors of Response to CRT) trial, in which no single LV mechanical dyssynchrony parameter could accurately predict response to CRT. 14 In this controversy, we advocate the use of LV mechanical dyssynchrony as an additional selection criterion for CRT and address the strengths of current imaging modalities to evaluate LV mechanical dyssynchrony. In addition, the different pathophysiological factors that may determine CRT response will be discussed. Finally, the use of an integrated approach, including LV mechanical dyssynchrony, LV lead position, and extent of myocardial scar, will be proposed as a potential optimal strategy to evaluate candidates for CRT.

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Left ventricular systolic asynchrony after acute myocardial infarction in patients with narrow QRS complexes

Cited by 73 publications

References 27 publications

Mechanical Dyssynchrony After Myocardial Infarction in Patients With Left Ventricular Dysfunction, Heart Failure, or Both

Mechanical Dyssynchrony After Myocardial Infarction in Patients With Left Ventricular Dysfunction, Heart Failure, or Both

Acute effect of primary percutaneous coronary intervention on left ventricular dyssynchrony in ST-segment elevation myocardial infarction

Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Clinically Useful

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