Right heart function interacts with left ventricular remodeling after CRT: A pressure volume loop study

Schmeißer, Alexander; Rauwolf, Thomas; Ghanem, Ali; Groscheck, Thomas; Adolf, Daniela; Grothues, Frank; Fischbach, Katharina; Kosiek, Ortrud; Huth, Christof; Kropf, Siegfried; Lange, Stefan; Luani, Blerim; Šmíd, Jan; Schäfer, Marc Henning; Schreiber, Jens; Tanev, Ivan; Wengler, Fabian; Yeritsyan, Naira; Steendijk, Paul; Braun‐Dullaeus, Ruediger C.

doi:10.1016/j.ijcard.2018.03.026

Cited by 11 publications

(14 citation statements)

References 19 publications

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“…This result is partly due to CRT-induced volumetric chambers reduction with consequent improvement of mitral regurgitation and pulmonary vein hypertension and with an additional positive effect on the mechanics of the inter-ventricular septum. Moreover, RV coupling to the pulmonary arterial circulation (RV-PA coupling) is associated with a greater LV remodeling after CRT [79].…”

Section: Right Ventricular Function and Resynchronization Therapymentioning

confidence: 99%

Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

Monitillo¹,

Terlizzi

Gioia

et al. 2020

JCDD

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There is growing attention for the study of the right ventricle in cardiovascular disease and in particular in heart failure. In this clinical setting, right ventricle dysfunction is a significant marker of poor prognosis, regardless of the degree of left ventricular dysfunction. Novel echocardiographic methods allow for obtaining a more complete evaluation of the right ventricle anatomy and function as well as of the related abnormalities in filling pressures. Specific and effective therapies for the right ventricle dysfunction are still not well defined and this represents the most difficult and important challenge. This article focuses on available diagnostic techniques for studying right ventricle dysfunction as well as on the therapies for right ventricle dysfunction.

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Section: Right Ventricular Function and Resynchronization Therapymentioning

confidence: 99%

Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

Monitillo¹,

Terlizzi

Gioia

et al. 2020

JCDD

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“…This study uses data that were obtained retrospectively from the University Hospital Magdeburg, Department of Cardiology [50]. An exemplary subject was selected who involved a dilated LV and suffered from systolic left-sided heart failure.…”

Section: Clinical Data and Model Personalizationmentioning

confidence: 99%

A Personalized Switched Systems Approach for the Optimal Control of Ventricular Assist Devices based on Atrioventricular Plane Displacement

Zeile

Rauwolf

Schmeißer

et al. 2020

Preprint

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Objective: A promising treatment for congestive heart failure is the implementation of a left ventricular assist device (LVAD) that works as a mechanical pump. Modern LVADs work with adjustable constant rotor speed and provide therefore continuous blood flow; however, recently undertaken efforts try to mimic pulsatile blood flow by oscillating the pump speed. This work proposes an algorithmic framework to construct and evaluate optimal pump speed policies. Methods: We use a model that captures the atrioventricular plane displacement, which is a physiological indicator for heart failure. We employ mathematical optimization to adapt this model to patient specific data and to find optimal pump speed policies with respect to ventricular unloading and aortic valve opening. To this end, we reformulate the cardiovascular dynamics into a switched system and thereby reduce nonlinearities. We consider system switches that stem from varying the constant pump speed and that are state dependent such as valve opening or closing. Results: As a proof of concept study, we personalize the model to a selected patient with respect to ventricular pressure. The model fitting results in a root-mean-square deviation of about 6 mmHg. Optimized constant and piecewise constant rotor speed profiles improve the default initialized solution by 31% and 68% respectively. Conclusion: These in silico findings demonstrate the potential of personalized hemodynamical optimization for the LVAD therapy. Significance: LVADs and their optimal configuration are active research fields. Mathematical optimization enhances our understanding of how LVADs should provide pulsatility.

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“…A previous meta-analysis revealed that echocardiographic parameters of RV function do not predict CRT response-related changes in LVEF [37]. In contrast, a recent study reported that RV systolic dysfunction before CRT implantation could identify patients that might not benefit from CRT [38], and a prospective study concluded that CRT induces RV reverse remodeling and improves RV function with improved interventricular dependence [39]. Furthermore, a higher baseline RV-pulmonary artery (PA) coupling is associated with improved LV reverse remodeling and independently associated with a better prognosis [40].…”

Section: Concomitant Cardiac Conditionsmentioning

confidence: 99%

“…Furthermore, a higher baseline RV-pulmonary artery (PA) coupling is associated with improved LV reverse remodeling and independently associated with a better prognosis [40]. Of note, the response to CRT was strongly associated with RV-PA coupling in both studies [39, 40]. However, using the RV-to-PA ratio as a potential guide for CRT in patients with diseases in whom RV failure predominates needs further investigation [39, 40].…”

Section: Concomitant Cardiac Conditionsmentioning

confidence: 99%

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Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

et al. 2019

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Since the first report on biventricular pacing in 1994, cardiac resynchronization therapy (CRT) has become standard for patients with advanced heart failure (HF) and ventricular conduction delay. CRT improves myocardial function by resynchronizing myocardial contraction, which results in reverse left ventricular remodeling and improves symptoms and clinical outcomes. Despite the accelerated development of CRT device technology and its increased application in treating HF patients, almost one-third of these patients do not respond to the therapy or gain any clinical benefit from device implantation. Over the last decade, multiple cardiac imaging modalities have provided a deeper understanding of myocardial pathophysiology, thereby improving HF treatment management. However, the optimal strategy for improving the CRT response remains debatable. This article provides an updated overview of the electropathophysiology of myocardial dysfunction in ventricular conduction delay and the diagnostic approaches involving the use of multiple modalities.

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Right heart function interacts with left ventricular remodeling after CRT: A pressure volume loop study

Cited by 11 publications

References 19 publications

Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

A Personalized Switched Systems Approach for the Optimal Control of Ventricular Assist Devices based on Atrioventricular Plane Displacement

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

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