P4354Regional Strain Pattern Index - A novel technique to predict CRT response

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Orszulak ◽  
K Mizia-Stec ◽  
W Wrobel ◽  
A Berger-Kucza ◽  
W Orszulak ◽  
...  
Keyword(s):  
Roc Curve ◽  
Pattern Analysis ◽  
Nyha Class ◽  
Strain Curve ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Systolic Volume ◽  
Strain Pattern ◽  
Pattern Index ◽  
Crt Response

Abstract Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure individuals. Despite many efforts 30–40% patients with CRT still do not respond to therapy. Purpose The purpose was to propose and evaluate a novel dyssynchrony scoring system – Regional Strain Pattern Index (RSPI) in prediction of response to CRT. Methods Forty-nine HF patients (age: 66.5±10 years, LV ejection fraction: 24.9±6.4%, QRS: 173.1±19.1 ms, NYHA class II/III: 34.7%/63.3%, ischemic aetiology: 57.1%) underwent CRT implantation. Transthoracic echocardiography was performed before and 15±7 months after CRT implantation. Baseline dyssynchrony was studied by standard indices, strain pattern analysis and novel, author's index- RSPI. RSPI constitutes a method of quantification of LBBB-related strain curve pattern analysis. RSPI was calculated using longitudinal strain by 2D speckle tracking as the sum of dyssynchronous components across 12 segments from all three apical views. In one view, four components were assessed: 1) the contraction of the early-activated wall, 2) the prestretching of the late activated wall, 3) the contraction of the early-activated wall in the first 70% of the systolic ejection phase and 4) the peak contraction of the late-activated wall after aortic valve closure. One point was attributed to each component, thus the maximum was 12 points. RSPI was prospectively evaluated in predicting response to CRT. The response to CRT was defined as ≥15% reduction in the left ventricular end-systolic volume after 15 month follow-up. Results Thirty-six (73.5%) patients were responders. There were no significant differences in the baseline demographics, clinical, echocardiographic parameters between responders and non-responders. The mean RSPI in the overall population was 5.39±2.9 and higher RSPI values were observed in responders (5.86±2.9) than in non-responders (4.08±2.4, p=0.044). The ROC curve indicated that RSPI significantly predicted CRT response (area under curve, AUC=0.691, p=0.014) with the cut-off value at 7 points. Therefore, study population was divided into two groups according to RSPI score: ≥7 points (19 patients, 38.8% of population) and <7 points (30 patients, 61.2%). In univariate logistic regression analysis, among all of the dyssynchrony indices only RSPI≥7 points predicted the positive response to CRT (OR: 12; 95% CI=1.33–108.17; p=0.0036) with specificity of 92.3%, sensitivity of 50%, positive of 64.7% and negative of 40% predictive value for CRT response. ROC curve for RSPI Conclusion RSPI constitutes a novel, valuable predictor for CRT response. Acknowledgement/Funding Grant for scientific research in the field of CRT efficacy funded by Medical University of Silesia.

Prognostic value of diastolic function assessment in patients undergoing cardiac resynchronization therapy

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Galli ◽  
OA Smiseth ◽  
JM Aalen ◽  
CK Larsen ◽  
E Sade ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Primary Endpoint ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Systolic Volume ◽  
Funding Sources ◽  
American Society ◽  
Sensitivity Specificity ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: None. Objective The best modality to assess diastolic function in CRT-candidates is an object of debate and the relationship between diastolic function, CRT-response and survival are not clearly understood. Purpose of the study: to assess diastolic patterns in patients undergoing CRT according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging and to evaluate the prognostic value of diastolic dysfunction (DD) in CRT candidates. Methods 193 patients (age: 67 ± 11 years, QRS width: 167 ± 21 ms) were included in this multicentre prospective study. Patients were stratified according to DD grades (grade I to III). CRT-response was defined as a reduction of left ventricular (LV) end-systolic volume &gt;15% at 6-month follow-up (FU). The primary endpoint was defined as a composite of heart transplantation, LV assisted device implantation or all-cause death during FU. Results During FU, 132 (68%) patients were CRT-responders. CRT delivery was associated with diastolic function degradation in non-responders. Grade I DD was able to predict CRT-response with a sensitivity, specificity and accuracy of 70%, 65%, and 63%, respectively. After a median period of 35 months, the primary endpoint occurred in 29 (15%) patients. Grade I DD was associated with a better outcome [HR 0.26 95% CI: (0.10-0.66)], independently from ischemic cardiomyopathy, LV dyssynchrony and CRT-response (Table 1). Non-responders with grade II or grade III DD had the worse prognosis (HR 4.36, 95%CI: 2.10-9.06) Figure 1. Conclusions Grade I DD is associated with LV remodelling after CRT and is an independent predictor of prognosis in CRT candidates. Abstract Figure.

scholarly journals Non-invasive myocardial workiIndices derived from left ventricular pressure-strain loops in predicting the response to cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.R Zhu ◽  
X Shu ◽  
H.Y Chen ◽  
Y.N Wang ◽  
Y.F Cheng ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
Non Invasive ◽  
Work Distribution ◽  
Constructive Work ◽  
Crt Response

Abstract Background Non-invasive left ventricular (LV) pressure-strain loops (PSLs) which generated by combining LV longitudinal strain with brachial artery blood pressure, provide a novel method of quantifying global and segmental myocardial work (MW) indices with potential advantages over conventional echocardiographic strain which is load-dependent. The method has been introduced in echocardiographic software recently, making MW calculations more effectively and rapidly. The aim was to evaluate the role of non-invasive MW indices derived from LV PSLs in the prediction of cardiac resynchronization therapy (CRT) response. Methods 106 heart failure (HF) patients scheduled for CRT were included for MW analysis. Global and segmental (septal and lateral at the mid-ventricular level) MW indices were accessed before CRT. Response to CRT was defined as ≥15% reduction in LV end-systolic volume at 6-month follow-up in comparison with baseline value. Results CRT response was observed in 78 (74%) patients. At baseline, global work index (GWI) and global constructive work (GCW) were significant higher in CRT responders than in non-responders (both P&lt;0.05). Besides, responders exhibited a significantly higher Mid Lateral MW and Mid Lateral constructive work (CW) (both P&lt;0.001) but a significantly lower Mid Septal MW and Mid Septal myocardial work efficiency (MWE), as well as a significantly higher Mid Septal wasted work (WW) than non-responders (all P&lt;0.01). Baseline Mid Septal MWE (OR 0.975, 95% CI 0.959–0.990, P=0.002) and Mid Lateral MW (OR 1.003, 95% CI 1.002–1.004, P&lt;0.001) were identified as independent predictors of CRT response in multivariate regression analysis. Mid Septal MWE ≤42% combined with Mid Lateral MW ≥740 mm Hg% predicted CRT response with the optimal sensitivity of 79% and specificity of 82% (AUC = 0.830, P&lt;0.001). Conclusion Mid Septal MWE and Mid Lateral MW can successfully predict response to CRT, and their combination can further improve the prediction accuracy. Assessment of MW indices before CRT could identify the marked misbalance in LV myocardial work distribution and has the potential to be widely used as a reliable complementary tool for guiding patient selection in clinical practice. Funding Acknowledgement Type of funding source: None

Abstract 3096: Does The Extent Of Non Viable Myocardium, As Identified By Delayed Enhancement Cardiac Magnetic Resonance, Preclude Response After Cardiac Resynchronization Therapy?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
C Parsai ◽  
N Bunce ◽  
G.R Sutherland ◽  
A Baltabaeva ◽  
B Bijnens ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Biventricular Pacing ◽  
Nyha Class ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Delayed Enhancement ◽  
Cardiac Resynchronization ◽  
Systolic Volume ◽  
Myocardial Scarring

Cardiac resynchronisation therapy (CRT) is a recognised treatment for symptomatic left ventricular (LV) failure associated with a broad QRS.It has been suggested that >15% myocardial scarring predicted failure to respond to CRT. To determine if the scar burden is a major determinant in response to CRT, we prospectively studied 50 pts (66± 1 years, ischaemic aetiology 57%) undergoing CRT for standard indications at baseline (NYHA: 3±0.4, EF: 23±0.8%, QRS: 150±7 ms, BNP: 495±461 pmol/l) and 6 months post-CRT. Clinical response was defined by a reduction in NYHA class >1 and in BNP level >30%. Reverse LV remodelling was defined as a reduction in end-systolic volume ≥10%. All patients had an echocardiographic examination, including an assessment of dyssynchrony. Additionally, a Cardiac Magnetic Resonance (CMR) study, with delayed enhancement, was performed in patients without contraindications. Of the 30 patients that had CMR, 23 pts (77%) responded clinically to CRT (reduction in NYHA: 1.6±0.6, reduction in BNP: 34±0.4%) and 19/30 (63%) additionally displayed reverse LV remodelling. Among the clinical responders 8 pts (35% of responders) were found to have extensive full thickness myocardial scarring on CMR (in 7 ±1 segments), predominantly in the anteroseptum and apex (86%). Three of these patients also showed significant echocardiographic reverse remodelling. The mechanism of response to CRT in these patients with extensive infarction was more frequently interventricular resynchronisation (43%) or atrio-ventricular resynchronisation (43%) rather than intra-ventricular resynchronisation (14%).The previously suggested 12 segment dyssynchrony index (DI) would have identified none of these responders with extensive myocardial infarction. The DI identified only 7/23 responders (30%). Conclusion : Even patients with extensive myocardial scar are potential responders to CRT and should not be excluded if they fulfil the standard AHA/ESC criteria for biventricular pacing. Intraventricular resynchronisation is not the only mechanism by which patients respond to CRT and measures of intraventricular dyssynchrony alone are inadequate for identifying potential response

scholarly journals Segment length in cine (SLICE) strain analysis: a practical approach to estimate potential benefit from cardiac resynchronization therapy

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Alwin Zweerink ◽  
Robin Nijveldt ◽  
Natalia J. Braams ◽  
Alexander H. Maass ◽  
Kevin Vernooy ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Potential Benefit ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Segment Length ◽  
Resynchronization Therapy ◽  
Strain Pattern ◽  
Crt Response

Abstract Background Segment length in cine (SLICE) strain analysis on standard cardiovascular magnetic resonance (CMR) cine images was recently validated against gold standard myocardial tagging. The present study aims to explore predictive value of SLICE for cardiac resynchronization therapy (CRT) response. Methods and results Fifty-seven patients with heart failure and left bundle branch block (LBBB) were prospectively enrolled in this multi-center study and underwent CMR examination before CRT implantation. Circumferential strains of the septal and lateral wall were measured by SLICE on short-axis cine images. In addition, timing and strain pattern parameters were assessed. After twelve months, CRT response was quantified by the echocardiographic change in left ventricular (LV) end-systolic volume (LVESV). In contrast to timing parameters, strain pattern parameters being systolic rebound stretch of the septum (SRSsep), systolic stretch index (SSIsep-lat), and internal stretch factor (ISFsep-lat) all correlated significantly with LVESV change (R − 0.56; R − 0.53; and R − 0.58, respectively). Of all strain parameters, end-systolic septal strain (ESSsep) showed strongest correlation with LVESV change (R − 0.63). Multivariable analysis showed ESSsep to be independently related to LVESV change together with age and QRSAREA. Conclusion The practicable SLICE strain technique may help the clinician to estimate potential benefit from CRT by analyzing standard CMR cine images without the need for commercial software. Of all strain parameters, end-systolic septal strain (ESSsep) demonstrates the strongest correlation with reverse remodeling after CRT. This parameter may be of special interest in patients with non-strict LBBB morphology for whom CRT benefit is doubted.

scholarly journals Septal scar predicts non-response to cardiac resynchronization therapy

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Kjellstad Larsen ◽  
J Duchenne ◽  
E Galli ◽  
JM Aalen ◽  
J Bogaert ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Characteristic Curve ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Scar Burden ◽  
Systolic Volume ◽  
The Impact ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority Norwegian Health Association Background Scar in the left ventricular (LV) posterolateral wall is associated with poor response to cardiac resynchronization therapy (CRT). The impact of septal scar, however, has been less thoroughly investigated. As recovery of septal function seems to be an important effect of CRT, we hypothesized that CRT response depends on septal viability. Aim The aim of the present study was to investigate the association between septal scar and volumetric response to CRT, and to compare the impact of scar located in septum to scar located in the posterolateral wall. Methods 128 patients with symptomatic heart failure undergoing CRT implantation based on current guidelines (ejection fraction 30 ± 8%, QRS-width 164 ± 17 ms) were included in the study. Volumes and ejection fraction were measured by echocardiography using the biplane Simpson’s method at baseline and six months follow up. Non-response was defined as less than 15% reduction in end-systolic volume. Scar was assessed by late gadolinium enhancement cardiac magnetic resonance, and reported as percentage scar per regional myocardial volume. Numbers are given in [median ;10-90% percentile]. Results Scar was present in 62 patients (48%). Scar burden was equal in septum [0% ;0-34%] and the posterolateral wall [0% ;0-36%], p = 0.10. 31 patients (24%) did not respond to CRT. The non-responders had higher scar burden than the responders in both septum [16% ;0-57% vs 0% ;0-23%, p &lt; 0.001] and the posterolateral wall [6% ;0-74% vs 0% ;0-22%, p &lt; 0.001]. In univariate regression analysis both septal and posterolateral scars correlated with non-response to CRT (r = 0.51 and r = 0.33, respectively). However, combined in a multivariate model only septal scar remained a significant marker of non-response (p &lt; 0.001), while posterolateral scar did not (p = 0.23). Septal scar ≥ 7.1% predicted non-response with a specificity of 81% and a sensitivity of 70% by receiver operating characteristic curve analyses. The area under the curve was 0.79 (95% confidence interval 0.70 – 0.89) (Figure). Conclusions Septal scar is more closely associated with volumetric non-response to CRT than posterolateral scar. Future studies should explore the correlation between regional scar burden and different functional parameters, and how they relate to CRT response. Abstract Figure. Septal scar predicts non-response to CRT

scholarly journals Imaging predictors of response to cardiac resynchronization therapy: left ventricular work asymmetry by echocardiography and septal viability by cardiac magnetic resonance

2020 ◽  
Vol 41 (39) ◽  
pp. 3813-3823 ◽  
Author(s):  
John M Aalen ◽  
Erwan Donal ◽  
Camilla K Larsen ◽  
Jürgen Duchenne ◽  
Mathieu Lederlin ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Term Survival ◽  
Entire Study ◽  
Systolic Volume ◽  
Crt Response

Abstract Aims  Left ventricular (LV) failure in left bundle branch block is caused by loss of septal function and compensatory hyperfunction of the LV lateral wall (LW) which stimulates adverse remodelling. This study investigates if septal and LW function measured as myocardial work, alone and combined with assessment of septal viability, identifies responders to cardiac resynchronization therapy (CRT). Methods and results  In a prospective multicentre study of 200 CRT recipients, myocardial work was measured by pressure-strain analysis and viability by cardiac magnetic resonance (CMR) imaging (n = 125). CRT response was defined as ≥15% reduction in LV end-systolic volume after 6 months. Before CRT, septal work was markedly lower than LW work (P &lt; 0.0001), and the difference was largest in CRT responders (P &lt; 0.001). Work difference between septum and LW predicted CRT response with area under the curve (AUC) 0.77 (95% CI: 0.70–0.84) and was feasible in 98% of patients. In patients undergoing CMR, combining work difference and septal viability significantly increased AUC to 0.88 (95% CI: 0.81–0.95). This was superior to the predictive power of QRS morphology, QRS duration and the echocardiographic parameters septal flash, apical rocking, and systolic stretch index. Accuracy was similar for the subgroup of patients with QRS 120–150 ms as for the entire study group. Both work difference alone and work difference combined with septal viability predicted long-term survival without heart transplantation with hazard ratio 0.36 (95% CI: 0.18–0.74) and 0.21 (95% CI: 0.072–0.61), respectively. Conclusion Assessment of myocardial work and septal viability identified CRT responders with high accuracy.

scholarly journals Using Machine-Learning for Prediction of the Response to Cardiac Resynchronization Therapy: the SMART-AV Study

2020 ◽  
Author(s):  
Stacey Howell ◽  
Tim Stivland ◽  
Kenneth Stein ◽  
Kenneth Ellenbogen ◽  
Larisa Tereshchenko
Keyword(s):  
Machine Learning ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Adaptive Lasso ◽  
Volume Index ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Crt Response

Introduction—We aimed to apply machine learning (ML) to develop a prediction model for cardiac resynchronization therapy (CRT) response. Methods and Results—Participants from the SmartDelay Determined AV Optimization (SMART-AV) trial (n=741; age, 66 ±11 yrs; 33% female; 100% NYHA III-IV; 100% EF≤35%) were randomly split into training & testing (80%; n=593), and validation (20%; n=148) samples. Baseline clinical, ECG, echocardiographic and biomarker characteristics, and left ventricular (LV) lead position (43 variables) were included in 6 ML models (random forests, convolutional neural network, lasso, adaptive lasso, plugin lasso, elastic net, ridge, and logistic regression). A composite of freedom from death and heart failure hospitalization and a >15% reduction in LV end-systolic volume index at 6-months post-CRT was the endpoint. The primary endpoint was met by 337 patients (45.5%). The adaptive lasso model was more accurate than class I ACC/AHA guidelines criteria (AUC 0.759; 95%CI 0.678-0.840 versus 0.639; 95%CI 0.554-0.722; P<0.0001), well-calibrated, and parsimonious (19 predictors; nearly half are potentially modifiable). The model predicted CRT response with 70% accuracy, 70% sensitivity, and 70% specificity, and should be further validated in prospective studies. Conclusions—ML predicts short-term CRT response and thus may help with CRT procedure planning.

scholarly journals Improvement of LV Reverse Remodeling Using Dynamic Programming of Fusion-Optimized Atrioventricular Intervals in Cardiac Resynchronization Therapy

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhongkai Wang ◽  
Pan Li ◽  
Bili Zhang ◽  
Jingjuan Huang ◽  
Shaoping Chen ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
The Impact

Background: The patient-tailored SyncAV algorithm shortens the QRS duration (QRSd) beyond what conventional biventricular (BiV) pacing can. However, evidence of the ability of SyncAV to improve the cardiac resynchronization therapy (CRT) response is lacking. The aim of this study was to evaluate the impact of CRT enhanced by SyncAV on echocardiographic and clinical responses.Methods and Results: Consecutive heart failure (HF) patients from three centers treated with a quadripolar CRT system (Abbott) were enrolled. The total of 122 patients were divided into BiV+SyncAV (n = 68) and BiV groups (n = 54) according to whether they underwent CRT with or without SyncAV. Electrocardiographic, echocardiographic, and clinical data were assessed at baseline and during follow-up. Echocardiographic response to CRT was defined as a ≥15% decrease in left ventricular end-systolic volume (LVESV), and clinical response was defined as a NYHA class reduction of ≥1. At the 6-month follow-up, the baseline QRSd and LVESV decreased more significantly in the BiV+SyncAV than in the BiV group (QRSd −36.25 ± 16.33 vs. −22.72 ± 18.75 ms, P &lt; 0.001; LVESV −54.19 ± 38.87 vs. −25.37 ± 36.48 ml, P &lt; 0.001). Compared to the BiV group, more patients in the BiV+SyncAV group were classified as echocardiographic (82.35 vs. 64.81%; P = 0.036) and clinical responders (83.82 vs. 66.67%; P = 0.033). During follow-up, no deaths due to HF deterioration or severe procedure related complications occurred.Conclusion: Compared to BiV pacing, BiV combined with SyncAV leads to a more significant reduction in QRSd and improves LV remodeling and long-term outcomes in HF patients treated with CRT.

scholarly journals Using Machine-Learning for Prediction of the Response to Cardiac Resynchronization Therapy: the SMART-AV Study

2020 ◽  
Author(s):  
Stacey Howell ◽  
Tim Stivland ◽  
Kenneth Stein ◽  
Kenneth Ellenbogen ◽  
Larisa G Tereshchenko
Keyword(s):  
Machine Learning ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Adaptive Lasso ◽  
Volume Index ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Crt Response

Background: There is a controversy whether the response of both sexes to cardiac resynchronization therapy (CRT) is similar. Optimal CRT delivery requires procedure planning. Objective: To apply machine learning (ML) to develop a prediction model for CRT response. Methods: Participants from the SmartDelay Determined AV Optimization (SMART-AV) trial (n=741; age, 66 ± 11 yrs; 33% female; 100% NYHA III-IV; 100% EF≤35%) were randomly split into training & testing (80%; n=593), and validation (20%; n=148) samples. The entropy balancing procedure was used to match for the means of 30 covariates in male and female groups. Baseline clinical, ECG, echocardiographic and biomarker characteristics, and left ventricular (LV) lead position (43 variables) were included in 6 ML models (random forests, convolutional neural network, lasso, adaptive lasso, plugin lasso, elastic net, ridge, and logistic regression). A composite of freedom from death and heart failure hospitalization and a >15% reduction in LV end-systolic volume index at 6-months post-CRT was the endpoint. Results: The primary endpoint was met by 337 patients (45.5%). Weighting resulted in a perfect balance of means of covariates in men and women. After reweighting, CRT response for women versus men was similar (OR 1.53; 95%CI 0.88-2.65; P=0.131). The adaptive lasso model was more accurate than class I ACC/AHA guidelines criteria (AUC 0.759; 95%CI 0.678-0.840 versus 0.639; 95%CI 0.554-0.722; P<0.0001), well-calibrated, and parsimonious (19 predictors; nearly half are potentially modifiable). Conclusions: After balancing for covariates, both sexes similarly benefit from CRT. ML predicts short-term CRT response and thus may help with CRT procedure planning.

scholarly journals 561 Targeting septal work and viability identifies responders to cardiac resynchronization therapy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Aalen ◽  
E Donal ◽  
C K Larsen ◽  
J Duchenne ◽  
M Cvijic ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Myocardial Strain ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Entire Study ◽  
Systolic Volume ◽  
Crt Response

Abstract Funding Acknowledgements The study was supported by Center for Cardiological Innovation. Introduction Septal dysfunction is the dominant mechanism of left ventricular (LV) failure in left bundle branch block (LBBB). We hypothesize that, provided septum is viable, septal function can recover and hence LV function improve after cardiac resynchronization therapy (CRT). Purpose To determine if combined assessment of septal function and viability identifies responders to CRT. Methods In a prospective multicenter study of 200 unselected patients referred for CRT, we measured myocardial strain by speckle-tracking echocardiography and regional work by pressure-strain analysis before and 7 ± 1 months after CRT. Viability was assessed by late gadolinium enhancement cardiac magnetic resonance imaging (n = 123). CRT response was defined as ≥15% reduction in LV end-systolic volume. Results Before CRT, septal work was 258 ± 463 and LV lateral wall work 1469 ± 674 mmHg·% (p &lt; 0.0001). In CRT responders, septal work was restored to 1243 ± 495 mmHg·%, whereas non-responders showed less marked improvement (p &lt; 0.0001). The figure illustrates a typical CRT responder with negative septal work and a large difference between work in the LV lateral wall and septum (panel A). There was no septal scar (panel B) and, after 6 months with CRT, septal work was recovered (panel C). Pressure-strain loops illustrate that CRT converted inefficient septal contractions with substantial negative (wasted) work to positive work throughout systole. For the entire study population, the difference between work in the LV lateral wall and septum predicted CRT response with area under the curve (AUC) 0.75 (95% CI: 0.68-0.83) and was feasible in 98% of patients. Furthermore, septal scar predicted non-response to CRT with AUC 0.76 (95% CI: 0.65-0.86). Combining work difference and septal viability improved AUC for CRT response to 0.85 (95% CI: 0.76-0.94) (figure panel D). The AUC was similar for QRS 120-150 and &gt;150 ms. Conclusions The proposed combined approach with assessment of septal work and viability identified CRT responders with high precision. Abstract 561 Figure.

Sign in / Sign up

Export Citation Format

Share Document