Prognostic value of left ventricular reverse remodeling and performance improvement after cardiac resynchronization therapy: A prospective study

Menet, Aymeric; Guyomar, Yves; Ennezat, Pierre‐Vladimir; Graux, P; Castel, Anne Laure; Delelis, François; Heuls, S.; Cuvelier, Estelle; Gevaert, Cécile; Goffic, Caroline Le; Tribouilloy, Christophe; Maréchaux, Sylvestre

doi:10.1016/j.ijcard.2015.11.091

Cited by 24 publications

(41 citation statements)

References 34 publications

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“…Response to CRT is commonly evaluated in terms of LV reverse remodeling. In clinical practice, a relative reduction of 15% or more in LV end‐systolic volume compared to baseline defines LV reverse remodeling and has been associated with better long‐term outcome after CRT . Other echocardiographic surrogates including improvement in LV ejection fraction and LV global longitudinal strain are also used in clinical practice .…”

Section: Echocardiography To Predict Response To Crt: the Classical Amentioning

confidence: 94%

“…[9][10][11] Other echocardiographic surrogates including improvement in LV ejection fraction and LV global longitudinal strain are also used in clinical practice. 11 Landmark reports from the early 2000s, describe the ability of echocardiographic indices to predict CRT response in HFrEF patients with electrical dyssynchrony (prolonged QRS duration >120 ms). Classically, mechanical dyssynchrony is evaluated in terms of atrioventricular dyssynchrony, interventricular dyssynchrony, and intraventricular dyssynchrony ( Fig.…”

Section: Echocardiography To Predict Response To Crt: the Classicalmentioning

confidence: 99%

“…In clinical practice, a relative reduction of 15% or more in LV end‐systolic volume compared to baseline defines LV reverse remodeling and has been associated with better long‐term outcome after CRT . Other echocardiographic surrogates including improvement in LV ejection fraction and LV global longitudinal strain are also used in clinical practice . Landmark reports from the early 2000s, describe the ability of echocardiographic indices to predict CRT response in HFrEF patients with electrical dyssynchrony (prolonged QRS duration >120 ms).…”

Section: Echocardiography To Predict Response To Crt: the Classical Amentioning

confidence: 99%

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Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

et al. 2016

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The role of echocardiography in improving the selection of patients who will benefit from cardiac resynchronization therapy (CRT) remains a source of debate. Although previous landmark reports have demonstrated a link between mechanical dyssynchrony, assessed by delays between left ventricle (LV) walls and response to CRT, the predictive value of these findings has not yet been confirmed in multicenter trials. Indeed, recent studies demonstrated that the classical assessment of LV mechanical dyssynchrony using delay between walls by echocardiography depends not only on LV electrical activation delay (electrical dyssynchrony), but also on abnormalities in regional contractility of the LV and/or loading conditions, which do not represent an appropriate target for CRT. Recent reports highlighted the value of new indices of electromechanical dyssynchrony obtained by echocardiography, to predict LV response and outcome after CRT including septal flash, left bundle branch block-typical pattern by longitudinal strain, apical rocking, septal strain patterns, and systolic stretch index. This was achieved using a mechanistic approach, based on the contractile consequences of electrical dyssynchrony. These indices are rarely found in patients with narrow QRS (<120 ms), whereas their frequency rises in patients with an increase in QRS duration (>120 ms). Theses indices should improve candidate selection for CRT in clinical practice, especially for patients in whom the benefit of CRT remains uncertain, for example, patients with intermediate QRS width (120-150 ms).

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Section: Echocardiography To Predict Response To Crt: the Classical Amentioning

confidence: 94%

Section: Echocardiography To Predict Response To Crt: the Classicalmentioning

confidence: 99%

Section: Echocardiography To Predict Response To Crt: the Classical Amentioning

confidence: 99%

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Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

et al. 2016

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“…B. MLWHFQ) beurteilt werden. Messbare Parameter zur Beurteilung des positiven Effekts einer kardialen Resynchronisationstherapie sind Erhöhung der maximalen Sauerstoffaufnahme (VO 2 max) in der Spiroergometrie, die Verbesserung der systolischen linksventrikulären Pumpfunktion in der Echokardiografie und ein reverses linksventrikuläres Remodelling mit einer Reduktion des linksventrikulären endsystolischen Volumens (LVESV) um mehr als 15 % zum Ausgangswert [5]. Über die Kriterien zur Definition einer Nonresponse kann man sicher diskutieren, allerdings sollte die optimale Therapie das Ziel sein.…”

Section: Introductionunclassified

Therapie von „Non-Respondern“ einer kardialen Resynchronisation

2018

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ZusammenfassungDie kardiale Resynchronisationstherapie (CRT) ist ein etabliertes Verfahren in der Therapie der Herzinsuffizienz. Trotzdem liegt die Rate der Patienten, die nicht von dieser Therapie profitieren, je nach Studie um die 30%. Klinische Effekte der CRT-Therapie zeigen sich erst innerhalb mehrerer Monate nach der Implantation des Aggregats und können individuell verschieden stark ausgeprägt sein. Risikogruppen sollten in der Nachverfolgung besonders berücksichtigt werden. Bei Nonresponse sollte eine vollständige Evaluation des klinischen Status und eine Kontrolle des CRT-Aggregats erfolgen. Die Therapie der Nonresponse dient zunächst der Optimierung des biventrikulären Stimulationsanteils. Zudem ist die adäquate Programmierung der Zeitsteuerung unter echokardiografischer Kontrolle oder nicht invasiver Blutdruckmessung zielführend. Allerdings sind auch eine optimale Patientenauswahl, eine fachgerechte Implantation und eine individuelle Aggregatprogrammierung entscheidend für das Erreichen eines Therapieerfolgs.

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“…However, in HF patients under CRT, reverse remodeling is able to predict long-term outcome with higher reproducibility and predictive power than changes in LVEF. Thus, reverse modeling defined as the changes in LV end-systolic volume relative to baseline (≥15%) is currently considered the strongest predictor of mortality and HF-hospitalization [19]. …”

Section: Introductionmentioning

confidence: 99%

Automated Classification of Severity in Cardiac Dyssynchrony Merging Clinical Data and Mechanical Descriptors

Santos‐Díaz

Valdés-Cristerna

Vallejo

et al. 2017

Computational and Mathematical Methods in Medicine

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Cardiac resynchronization therapy (CRT) improves functional classification among patients with left ventricle malfunction and ventricular electric conduction disorders. However, a high percentage of subjects under CRT (20%–30%) do not show any improvement. Nonetheless the presence of mechanical contraction dyssynchrony in ventricles has been proposed as an indicator of CRT response. This work proposes an automated classification model of severity in ventricular contraction dyssynchrony. The model includes clinical data such as left ventricular ejection fraction (LVEF), QRS and P-R intervals, and the 3 most significant factors extracted from the factor analysis of dynamic structures applied to a set of equilibrium radionuclide angiography images representing the mechanical behavior of cardiac contraction. A control group of 33 normal volunteers (28 ± 5 years, LVEF of 59.7% ± 5.8%) and a HF group of 42 subjects (53.12 ± 15.05 years, LVEF < 35%) were studied. The proposed classifiers had hit rates of 90%, 50%, and 80% to distinguish between absent, mild, and moderate-severe interventricular dyssynchrony, respectively. For intraventricular dyssynchrony, hit rates of 100%, 50%, and 90% were observed distinguishing between absent, mild, and moderate-severe, respectively. These results seem promising in using this automated method for clinical follow-up of patients undergoing CRT.

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Prognostic value of left ventricular reverse remodeling and performance improvement after cardiac resynchronization therapy: A prospective study

Cited by 24 publications

References 34 publications

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

Therapie von „Non-Respondern“ einer kardialen Resynchronisation

Automated Classification of Severity in Cardiac Dyssynchrony Merging Clinical Data and Mechanical Descriptors

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