Mechanical Dyssynchrony after Cardiac Resynchronization Therapy for Severely Symptomatic Heart Failure Is Associated with Risk for Ventricular Arrhythmias

Haugaa, Kristina H.; Marek, Josef; Ahmed, Mohammed; Ryo, Keiko; Adelstein, Evan; Schwartzman, David; Saba, Samir; Gorcsan, John

doi:10.1016/j.echo.2014.04.001

Cited by 40 publications

(22 citation statements)

References 32 publications

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“…8 In addition, a heterogeneous myocardial contraction pattern determined by a dyssynchronic ventricular contraction (known as MD or dyssynchrony) has also been demonstrated useful to predict ventricular arrhythmias. 6,7 In contrast to previous studies, [24][25][26] we did not find MD to be a strong predictor of ventricular tachyarrhythmias (Table 2). This might be because of the fact that we only obtained MD from 12 segments (apical 4-and 2-chamber views) instead of 18 segments or because 2DSE was performed on Digital Imaging and Communications in Medicine images leading to lower frame rates than used in previous studies.…”

Section: Myocardial Deformation and Prognosiscontrasting

confidence: 56%

“…[6][7][8]11 However, both GLS and mechanical dispersion (MD) are based on averaging regional differences in deformation timing and amplitude, and important abnormalities in regional function may be missed by dilution in this process. Furthermore, the local radius of curvature of the ventricle increases from the apex to the base of the heart and also from the lateral to the septal wall.…”

Section: Biering-sørensen Et Almentioning

confidence: 99%

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Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Knappe

Pouleur

Claggett

et al. 2017

Circ: Cardiovascular Imaging

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Background— Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics. Methods and Results— We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P <0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, −7.7% versus −8.8%; P <0.001; lateral-strain, −7.3% versus −7.9%; P =0.022; inferior-strain, −8.3% versus −9.9%; P <0.001; septal-strain, −9.1% versus −10.0%; P <0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03–1.13]; P =0.001; inferior: hazard ratio, 1.08 [1.04–1.12]; P <0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00–1.11]; P =0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P =0.005). Conclusions— Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00180271.

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Section: Myocardial Deformation and Prognosiscontrasting

confidence: 56%

Section: Biering-sørensen Et Almentioning

confidence: 99%

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Knappe

Pouleur

Claggett

et al. 2017

Circ: Cardiovascular Imaging

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“…12 Improved LV function by CRT has been shown to be associated with a reduced arrhythmia burden, 13 whereas persistent or new radial dyssynchrony or abnormal longitudinal strain is associated with an increased rate of ventricular arrhythmias or death. 14,15 The effect of LV resynchronization on the electrophysiologic substrate is a suggested mechanism. However, at present it has not been determined whether changes in APD during CRT relate to changes in regional mechanical function in humans.…”

Section: Introductionmentioning

confidence: 99%

Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and nonresponders to cardiac resynchronization therapy

et al. 2016

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Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and non-responders to cardiac resynchronization therapy, Heart Rhythm, http://dx.doi. org/10.1016/j.hrthm.2016.06.014 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…48 A known limitation of speckle-tracking echocardiography is that it cannot be applied to all patients. 15,46 However, we were able to obtain meaningful GLS and GCS results in >90% of consecutive patients. We acknowledge that a possible statistical limitation of this study is the potentially inflated type I error because of multiple testing.…”

Section: Study Limitationsmentioning

confidence: 99%

“…15 Although baseline dyssynchrony measured by radial delay (radial strain-derived septal to posterior wall delay) was evaluated in univariable and multivariable analyses, it was a limitation that follow-up assessment for resynchronization was not part of the current study. 9 The presence of dyssynchrony after CRT has been associated with worse clinical outcome in wide QRS patients 46,47 as well as narrow QRS. 48 A known limitation of speckle-tracking echocardiography is that it cannot be applied to all patients.…”

Section: Study Limitationsmentioning

confidence: 99%

Additive Prognostic Value of Echocardiographic Global Longitudinal and Global Circumferential Strain to Electrocardiographic Criteria in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy

Delgado-Montero

Tayal

Goda

et al. 2016

Circ: Cardiovascular Imaging

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Background-Response to cardiac resynchronization therapy is most favorable in patients with heart failure with QRS duration ≥150 ms and left bundle branch block and less predictable in those with QRS width 120 to 149 ms or non-left bundle branch block. Methods and Results-We studied 205 patients with heart failure referred for cardiac resynchronization therapy with QRS ≥120 ms and ejection fraction ≤35%. We tested the hypothesis that contractile function using speckle-tracking echocardiographic global circumferential strain (GCS) from 2 short-axis views and global longitudinal strain (GLS) from 3 apical views add prognostic value to electrocardiographic criteria. There were 112 patients (55%) with GLS >−9% and 136 patients (66%) with GCS >−9%. During 4 years, 81 patients reached the combined primary end point (death, circulatory support, or transplant) and 120 reached the secondary end point (heart failure hospitalization or death). Both GLS >−9% and GCS >−9% were associated with increased risk of unfavorable events as follows: for the primary end point (hazard ratio=2.91; 95% confidence interval, 1. Methods Patient PopulationThis was a prospective longitudinal study design at a single center. All patients fulfilled current criteria for CRT implant with New York Heart Association (NYHA) class II to IV HF on optimal pharmacological therapy, QRS width ≥120 ms, and LVEF ≤35%. This study was approved by the Institutional Review Board of Biomedical Research, and all patients gave informed consent according to this study protocol. Patients with chronic right ventricular pacing or a failed CRT implant were excluded. The study population included 205 consecutive CRT patients with baseline echocardiography suitable for speckle-tracking analysis, which was 91% of the initial cohort. Ischemic pathogenesis was defined as ≥70% stenosis in ≥1 epicardial coronary vessel on angiography or history of myocardial infarction or revascularization. Baseline LBBB and right bundle branch block (RBBB) morphology were defined using standard criteria. 11 Intraventricular conduction delay was defined as QRS duration ≥120 ms not meeting criteria for either LBBB or RBBB. Intermediate ECG criteria were QRS 120 to 149 ms, regardless of morphology or non-LBBB morphology (RBBB or intraventricular conduction delay). Patients with atrial fibrillation were not included. All patients had a biventricular pacing system implanted with a standard right atrial lead, a right ventricular apical lead, and LV lead positioned through the coronary sinus, targeting the lateral or posterolateral LV free wall. Patients were typically programmed to an atrioventricular interval of 120-130 ms with no ventricular-ventricular pacing offset. These patients did not routinely undergo formal atrioventricular or ventricular-ventricular optimization studies. 12 EchocardiographyAll echocardiographic studies were performed with similar echocardiography systems (Vivid 7; GE Vingmed, Horten, Norway). Routine echocardiography included standard apical views, and basal and mid-L...

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Mechanical Dyssynchrony after Cardiac Resynchronization Therapy for Severely Symptomatic Heart Failure Is Associated with Risk for Ventricular Arrhythmias

Cited by 40 publications

References 32 publications

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and nonresponders to cardiac resynchronization therapy

Additive Prognostic Value of Echocardiographic Global Longitudinal and Global Circumferential Strain to Electrocardiographic Criteria in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy

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