Sequence and timing of ventricular wall motion in patients with bundle branch block. Assessment by radionuclide cineangiography.

Rosenbush, Stuart W.; Ruggie, Neal; Turner, David A.; Behren, Patrick L. Von; Denes, Pablo; Fordham, Ernest W.; Groch, M. W.; Messer, Joseph V.

doi:10.1161/01.cir.66.5.1113

Cited by 43 publications

(17 citation statements)

References 15 publications

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“…Intraventricular dyssynchrony in left bundle-branch block is characterized by early septal contraction, which often peaks during the isovolumic contraction period with associated lateral prestretching. This finding has been demonstrated with the use of M-mode echocardiography, 27 cineangiography, 28 magnetic resonance imaging tagging, 29 -32 and tissue Doppler-derived strain imaging 33,34 in left bundle-branch block and right ventricular apical pacing. Forces generated by the early activated fibers are dissipated in generating sufficient energy to open the aortic valve and in prestretching the not-yet-activated fibers, which leads to a waste of energy.…”

Section: Advantage Of Strain Imaging For Evaluation Of Dyssynchronymentioning

confidence: 79%

Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes

Miyazaki

Lin

Powell

et al. 2008

Circ: Cardiovascular Imaging

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Background-Various dyssynchrony indexes derived from tissue velocity and strain imaging have been proposed to predict the effectiveness of cardiac resynchronization therapy (CRT). We sought to compare the effect of CRT on dyssynchrony indexes derived by tissue velocity and strain and to determine which baseline intraventricular dyssynchrony parameters correlate with improvement in left ventricular volume after CRT. Methods and Results-Echocardiography with tissue Doppler imaging was performed in 45 patients with systolic heart failure at baseline, 1 day after CRT, and a median of 6 months after CRT. We calculated septal-lateral delay and anteroseptal-posterior delay and standard deviation of time to peak systolic velocity in the 12 basal and mid-left ventricular segments (Tv-SD). The standard deviation for time to peak strain in the 12 basal and mid-left ventricular segments (T-SD) was calculated as a strain-derived dyssynchrony index. None of the tissue velocity-derived dyssynchrony indexes improved after CRT (septal-lateral delay, Pϭ0.39; anteroseptal-posterior delay, Pϭ0.46; Tv-SD, Pϭ0.30), whereas T-SD decreased significantly after CRT (PϽ0.001). Improvement in T-SD 1 day after CRT correlated with the reduction in end-systolic volume at follow-up (rϭ0.66; PϽ0.001). Baseline T-SD demonstrated significant correlation with the reduction of end-systolic volume at follow-up (rϭ0.57; PϽ0.001); however, baseline tissue velocity-derived dyssynchrony indexes failed to predict the effect of CRT. Conclusions-The strain-derived dyssynchrony index is a better measurement than the tissue velocity dyssynchrony index for monitoring changes in mechanical dyssynchrony after CRT and for predicting reduction in left ventricular volume after CRT. (Circ Cardiovasc Imaging. 2008;1:14-22.)

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Section: Advantage Of Strain Imaging For Evaluation Of Dyssynchronymentioning

confidence: 79%

Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes

Miyazaki

Lin

Powell

et al. 2008

Circ: Cardiovascular Imaging

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“…Mechanical dyssynchrony in LBBB or the paced heart is characterized by early septal contraction and prestretching in the lateral wall, which often occurs during the isovolumic contraction period, and postsystolic contraction. [37][38][39] Therefore, assess- …”

Section: Dyssynchrony Measurement By Strainmentioning

confidence: 99%

Comparison of Echocardiographic Dyssynchrony Assessment by Tissue Velocity and Strain Imaging in Subjects With or Without Systolic Dysfunction and With or Without Left Bundle-Branch Block

et al. 2008

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Background-Several echocardiographic dyssynchrony indexes have been proposed to identify responders to cardiac resynchronization therapy using tissue velocity and strain. The present study aimed to compare tissue velocity-derived and strain-derived dyssynchrony indexes in patients with or without systolic dysfunction and left bundle-branch block. Methods and Results-Tissue Doppler imaging was performed in 120 subjects divided into 4 groups: group 1 (nϭ40), normal subjects; group 2 (nϭ20), normal left ventricular ejection fraction and left bundle-branch block; group 3 (nϭ20), left ventricular ejection fraction Ͻ35% and normal conduction; and group 4 (nϭ40), left ventricular ejection fraction Ͻ35% and left bundle-branch block. Dyssynchrony indexes based on time to peak tissue velocity (septal-lateral delay, anteroseptal-posterior delay, and SD in time to peak systolic velocity in the 12 left ventricular segments) and strain (SD of time to peak strain in 12 segments) were measured. The SD in time to peak systolic velocity in the 12 left ventricular segments was greater in group 4 (54 ms; 25th and 75th percentiles, 46 to 64 ms) than group 1 (44 ms; 25th and 75th percentiles, 28 to 53 ms; Pϭ0.006), but there was a considerable overlap of all tissue velocity-derived indexes among 4 groups, with 40% to 68% of group 1 having values proposed for predicting the responders of cardiac resynchronization therapy. The SD of time to peak strain in 12 segments distinguished these groups with much less overlap (PϽ0.01 for all pairwise comparisons). Conclusions-A substantial proportion of normal subjects have tissue velocity-derived dyssynchrony indexes higher than the cutoff value proposed for predicting beneficial effect of cardiac resynchronization therapy. Strain-derived timing index appears to be more specific for dyssynchrony in patients with systolic dysfunction and left bundle-branch block.Identifying an optimal tissue velocity-or strain-derived dyssynchrony index requires a large prospective clinical trial.

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“…Early on, phase analysis was used with equilibrium radionuclide angiography (15) and applied to the characterization of abnormal patterns of ventricular activation (16), including the diagnosis of bundle branch blocks (17,18). More recently, phase analysis has been applied to gated myocardial perfusion SPECT (MPS), in which global synchrony measures derived from countbased thickening (19) have been shown to correlate with tissue Doppler imaging-derived measures of intraventricular delay (20) and, in a preliminary study, to predict response to CRT (21).…”

mentioning

confidence: 99%

Automatic Global and Regional Phase Analysis from Gated Myocardial Perfusion SPECT Imaging: Application to the Characterization of Ventricular Contraction in Patients with Left Bundle Branch Block

Kriekinge¹,

Nishina²,

Ohba³

et al. 2008

J Nucl Med

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Although many patients with heart failure benefit from cardiac resynchronization therapy (CRT), predicting which patients will respond to CRT remains challenging. Recent evidence suggests that the analysis of mechanical dyssynchrony using gated myocardial perfusion SPECT (MPS) may be an effective tool. The aim of this study was to evaluate global and regional gated MPS dyssynchrony measurements by comparing parameters obtained from patients with a low likelihood (LLk) of conduction abnormalities and coronary artery disease and patients with left bundle branch block (LBBB). Methods: A total of 86 consecutive patients with LLk and 72 consecutive patients with LBBB, all without prior myocardial infarction or sternotomy, were studied using gated MPS. Global (histogram SD [s], bandwidth [b], and entropy [e]) and regional (wall-and segment-based differences of means [Dm W and Dm S , respectively] or modes [DM W and DM S , respectively]) dyssynchrony measures were calculated by Fourier harmonic phase-angle analysis of local myocardial count variations over the cardiac cycle for each patient, and then unpaired t tests were used to determine which parameters were sex-specific and how well they discriminated between the LLk and LBBB populations. Receiver-operating-characteristic analysis was also performed to calculate the area under the curve (AUC), sensitivity (Ss), specificity (Sp), and optimal threshold (Th). Results: Global parameters were found to be sex-specific, whereas regional differences were sex-independent. All parameters studied showed statistically significant differences between the groups (all global, P , 0.05; all regional, P , 0.0001). Receiver-operating-characteristic analysis yielded higher AUC, Ss, and Sp for e and regional parameters (e: AUC 5 The computed parameters all discriminate effectively between LLk and LBBB populations. Measurements that are less dependent on the shape of the phase-angle distribution histogram provided higher sensitivity and specificity for this purpose. Further study is needed to evaluate these parameters for the purpose of predicting response to CRT.Key Words: left ventricular dyssynchrony; left bundle branch block; cardiac resynchronization therapy; myocardial perfusion gated SPECT

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Sequence and timing of ventricular wall motion in patients with bundle branch block. Assessment by radionuclide cineangiography.

Cited by 43 publications

References 15 publications

Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes

Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes

Comparison of Echocardiographic Dyssynchrony Assessment by Tissue Velocity and Strain Imaging in Subjects With or Without Systolic Dysfunction and With or Without Left Bundle-Branch Block

Automatic Global and Regional Phase Analysis from Gated Myocardial Perfusion SPECT Imaging: Application to the Characterization of Ventricular Contraction in Patients with Left Bundle Branch Block

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