scholarly journals The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients

EP Europace ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 777-786 ◽  
Author(s):  
Francesco Maffessanti ◽  
Tomasz Jadczyk ◽  
Radosław Kurzelowski ◽  
François Regoli ◽  
Maria Luce Caputo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Activation ◽  
Electromechanical Coupling ◽  
Biological Therapy ◽  
Left Ventricular ◽  
Electrical Activation ◽  
Cardiac Resynchronization ◽  
Spatio Temporal ◽  
Activation Times ◽  
The Relationship

Abstract Aims The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar. Methods and results Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n–27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72–0.89) vs. 0.74 (0.52–0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54–81) vs. 56% (36–73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9–17.4) vs. 20.3 (6.9–29.4) % of left ventricular radius, P = 0.02]. Conclusion Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.

scholarly journals The Relationship of Myocardial Collagen Metabolism and Reverse Remodeling after Cardiac Resynchronization Therapy

2016 ◽  
Vol 35 (2) ◽  
pp. 130-136 ◽  
Author(s):  
Ivana Petrovic ◽  
Ivan Stankovic ◽  
Goran Milasinovic ◽  
Gabrijela Nikcevic ◽  
Bratislav Kircanski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Collagen Synthesis ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Relationship Of ◽  
The Relationship ◽  
Myocardial Collagen

SummaryBackground:In the majority of patients with a wide QRS complex and heart failure resistant to optimal medical therapy, cardiac resynchronization therapy (CRT) leads to rever se ventricular remodeling and possibly to changes in cardiac collagen synthesis and degradation. We investigated the relationship of biomarkers of myocardial collagen meta bolism and volumetric response to CRT.Methods:We prospectively studied 46 heart failure patients (mean age 61±9 years, 87% male) who underwent CRT im plantation. Plasma concentrations of amino-terminal pro peptide type I (PINP), a marker of collagen synthesis, and carboxy-terminal collagen telopeptide (CITP), a marker of collagen degradation, were measured before and 6 months after CRT. Response to CRT was defined as 15% or greater reduction in left ventricular end-systolic volume at 6-month follow-up.Results:Baseline PINP levels showed a negative correlation with both left ventricular end-diastolic volume (r=−0.51; p=0.032), and end-systolic diameter (r=−0.47; p=0.049). After 6 months of device implantation, 28 patients (61%) responded to CRT. No significant differences in the base-line levels of PINP and CITP between responders and nonresponders were observed (p>0.05 for both). During follow-up, responders demonstrated a significant increase in serum PINP level from 31.37±18.40 to 39.2±19.19 μg/L (p=0.049), whereas in non-responders serum PINP levels did not significantly change (from 28.12±21.55 to 34.47±18.64 μg/L; p=0.125). There were no significant changes in CITP levels in both responders and non-responders (p>0.05).Conclusions:Left ventricular reverse remodeling induced by CRT is associated with an increased collagen synthesis in the first 6 months of CRT implantation.

Abstract 16755: Personalized Virtual Cardiac Resynchronization Therapy Simulation Based on a 12-Lead ECG and CMR Predicts Electrical Activation Changes After Cardiac Resynchronization Therapy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kenneth C Bilchick ◽  
Eric Lluch ◽  
Pim Oomen ◽  
Xu Gao ◽  
Jeffrey W Holmes ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Implementation Strategies ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Electrical Activation ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Simulation Based ◽  
Qrs Duration ◽  
Activation Times

Introduction: Simulating electrical remodeling after cardiac resynchronization therapy (CRT) based on individual patient characteristics could enhance the effectiveness of the procedure, help select optimal CRT candidates, and yield important prognostic data. Hypothesis: A Virtual CRT (V-CRT) simulation based on the 12-lead ECG and cardiac magnetic resonance (CMR) for evaluation of biventricular structure and extent of scar with late gadolinium enhancement (LGE) would predict changes in electrical activation after CRT. Methods: V-CRT uses cardiac geometry and scar (LGE) from CMR, a torso avatar from CMR scouts, and an electrophysiology model derived from the baseline ECG, the left ventricular (LV) pacing site, and programmed CRT pacing parameters. Ventricular activation times and the resulting QRS duration (QRSd) after CRT were estimated. The predicted QRS durations were then compared with the actual QRS durations after CRT pacing. Results: 20 CRT patients (age 67.3 ± 10.2 years, 30% female, 50% with LV scar) had a mean pre-CRT QRSd of 151 ± 12.8 ms. This predicted post-CRT QRSd depended significantly on the LV pacing site with a median maximum-minimum difference per patient over all possible pacing sites of 39.8 ms (IQR 32.5-44.2 ms). The post-CRT QRSd predicted by V-CRT based on the actual LV pacing site correlated well with the observed post-CRT QRS duration (r=0.51, p=0.02) (Figure). Predicted changes in the QRS duration were strongly associated with changes in LV activation times (r=0.74, p=0.0002), but not RV activation times (no correlation). Greater predicted reductions in LV activation times were more common in patients with greater LV end-diastolic volume indices (LVEDVIs) by CMR (r=-0.58, p=0.01). Conclusions: V-CRT effectively predicts changes in electrical activation after CRT. These findings have important implications for patient selection for CRT, prognosis after CRT, and CRT implementation strategies.

Time interval from left ventricular stimulation to QRS onset is a predictor of mortality in patients with cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Yagishita ◽  
Y Yagishita ◽  
S Kataoka ◽  
K Yazaki ◽  
M Kanai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Independent Predictor ◽  
Total Mortality ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Time Interval ◽  
Heart Failure Hospitalization ◽  
Conduction Disturbance ◽  
Secondary Endpoints ◽  
Fibrotic Lesion

Abstract Introduction In our previous report, the time interval from left ventricular (LV) pacing to the earliest onset of QRS (S-QRS interval) has been found to be an independent predictor of mechanical response to cardiac resynchronization therapy (CRT). The S-QRS interval may indicate the conduction disturbance relevant to the localized tissue property such as scar or fibrotic lesion. Therefore, S-QRS interval longer than 37ms was associated with poor response to CRT, and proposed as suboptimal LV lead position. Then, we hypothesized that the longer S-QRS interval at the LV pacing site could be related to long term mortality and heart failure events in patients with CRT. Methods This retrospective study included 82 consecutive heart failure patients with sinus rhythm, reduced LV ejection fraction (≤35%), and a wide QRS complex (≥120ms), who undergone CRT implantation between 2012 January and 2017 December. Patients were divided into Short S-QRS group (<37ms, SS-QRS) and Long S-QRS group (≥37ms, LS-QRS) according to the previously reported optimal cut off value. A responder was defined as one with ≥15% reduction in LV end-systolic volume assessed by echocardiography at 6 months after CRT. The primary endpoint was total mortality, which included LV assist device implantation or heart transplantation. The secondary endpoints included the composite endpoint of total mortality or heart failure hospitalization. Results The study patients were divided into SS-QRS (N=43, age 65.9±13.2 years, 77% male) and LS-QRS (N=39, age 63.0±13.4, 85% male). In the electrocardiographic measurements, there were no significant differences in baseline QRS duration (162.4±30.3ms in SS-QRS vs. 154.5±31.6ms in LS-QRS, P=0.19) and LV local activation time assessed as Q-LV interval (118.3±34.3ms in SS-QRS vs. 115.3±32.0ms in LS-QRS, P=0.71). S-QRS interval was 25.9±5.3ms in SS-QRS and 51.5±13.7ms in LS-QRS (P<0.01), and the responder rate was significantly higher in SS-QRS compared with LS-QRS (79% vs. 29%, P<0.01). During mean follow up of 47.7±22.4 months, 24 patients (29%) reached to the primary endpoint, while the secondary endpoints were observed in 47 patients (57%). LS-QRS patients had significantly worse event-free survival for both primary and secondary endpoints (Figure). After the multivariate Cox regression analysis, LS-QRS (≥37ms) was an independent predictor of total mortality (HR=2.6, 95% CI: 1.11 to 6.12, P=0.03) and the secondary composite events (HR=2.4, 95% CI: 1.31 to 4.33, P<0.01). Conclusion The S-QRS interval longer than 37ms, which may reflect the conduction disturbance relevant to the scar or fibrotic lesion at the LV pacing site, was a significant predictor of the total mortality and heart failure hospitalization. These findings have implications for the optimal LV lead placement in patients with CRT device. Clinical outcomes according to S-QRS Funding Acknowledgement Type of funding source: None

scholarly journals Importance of systematic right ventricular assessment in cardiac resynchronization therapy candidates: a machine-learning approach

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Galli ◽  
V Le Rolle ◽  
OA Smiseth ◽  
J Duchenne ◽  
JM Aalen ◽  
...  
Keyword(s):  
Machine Learning ◽  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Supervised Machine Learning ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite having all a systolic heart failure and broad QRS, patients proposed for cardiac resynchronization therapy (CRT) are highly heterogeneous and it remains extremely complicated to predict the impact of the device on left ventricular (LV) function and outcomes. Objectives We sought to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular (LV) remodeling and prognosis of CRT-candidates by the application of machine learning (ML) approaches. Methods 193 patients with systolic heart failure undergoing CRT according to current recommendations were prospectively included in this multicentre study. We used a combination of the Boruta algorithm and random forest methods to identify features predicting both CRT volumetric response and prognosis (Figure 1). The model performance was tested by the area under the receiver operating curve (AUC). We also applied the K-medoid method to identify clusters of phenotypically-similar patients. Results From 28 clinical, electrocardiographic, and echocardiographic-derived variables, 16 features were predictive of CRT-response; 11 features were predictive of prognosis. Among the predictors of CRT-response, 7 variables (44%) pertained to right ventricular (RV) size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with a very good prediction of both CRT response (AUC 0.81, 95% CI: 0.74-0.87) and outcomes (AUC 0.84, 95% CI: 0.75-0.93) (Figure 1, Supervised Machine Learning Panel). An unsupervised ML approach allowed the identifications of two phenogroups of patients who differed significantly in clinical and parameters, biventricular size and RV function. The two phenogroups had significant different prognosis (HR 4.70, 95% CI: 2.1-10.0, p < 0.0001; log –rank p < 0.0001; Figure 1, Unsupervised Machine Learning Panel). Conclusions Machine learning can reliably identify clinical and echocardiographic features associated with CRT-response and prognosis. The evaluation of both RV-size and function parameters has pivotal importance for the risk stratification of CRT-candidates and should be systematically assessed in patients undergoing CRT. Abstract Figure 1

scholarly journals Uric Acid, Oxidative Stress and Inflammation in Chronic Heart Failure with Reduced Ejection Fraction

2015 ◽  
Vol 23 (4) ◽  
pp. 397-406 ◽  
Author(s):  
Adriana Iliesiu ◽  
Alexandru Campeanu ◽  
Daciana Marta ◽  
Irina Parvu ◽  
Gabriela Gheorghe
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Uric Acid ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Xanthine Oxidase ◽  
Left Ventricular ◽  
Paraoxonase 1 ◽  
Lv Function ◽  
The Relationship

Abstract Background. Oxidative stress (OS) and inflammation are major mechanisms involved in the progression of chronic heart failure (CHF). Serum uric acid (sUA) is related to CHF severity and could represent a marker of xanthine-oxidase activation. The relationship between sUA, oxidative stress (OS) and inflammation markers was assessed in patients with moderate-severe CHF and reduced left ventricular (LV) ejection fraction (EF). Methods. In 57 patients with stable CHF, functional NYHA class III, with EF<40%, the LV function was assessed by N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) levels and echocardiographically through the EF and E/e’ ratio, a marker of LV filling pressures. The relationship between LV function, sUA, malondialdehyde (MDA), myeloperoxidase (MPO), paraoxonase 1 (PON-1) as OS markers and high sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) as markers of systemic inflammation was evaluated. Results. The mean sUA level was 7.9 ± 2.2 mg/dl, and 61% of the CHF patients had hyperuricemia. CHF patients with elevated LV filling pressures (E/e’ ≥ 13) had higher sUA (8.6 ± 2.3 vs. 7.3 ± 1.4, p=0.08) and NT-proBNP levels (643±430 vs. 2531±709, p=0.003) and lower EF (29.8 ± 3.9 % vs. 36.3 ± 4.4 %, p=0.001). There was a significant correlation between sUA and IL-6 (r = 0.56, p<0.001), MDA (r= 0.49, p= 0.001), MPO (r=0.34, p=0.001) and PON-1 levels (r= −0.39, p= 0.003). Conclusion. In CHF, hyperuricemia is associated with disease severity. High sUA levels in CHF with normal renal function may reflect increased xanthine-oxidase activity linked with chronic inflammatory response.

scholarly journals Features of the relationship between the parameters of left ventricular mechanics and the level of biomarkers of heart failure in patients with epicardial obesity

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
O Gritsenko ◽  
GA Chumakova
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Speckle Tracking ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Serum Biomarker ◽  
Volume Index ◽  
Time To Peak ◽  
Ventricular Mechanics ◽  
The Relationship

Abstract Funding Acknowledgements Type of funding sources: None. Currently, there is no serum biomarker that is a marker of the presence of heart failure (HF) at an early stage. It is also shown that the traditional indicators used for the diagnosis diastolic dysfunction (DD) of left ventricular (LV) using echocardiography (ECG) are not informative enough. Thus, it is currently relevant to study new serum biomarkers of DD, such as sST2, as well as to study the mechanics of LV. Objective to study the relationship between mechanics of LV and the level of sST2 (bioamarker of HF) in patients with epicardial obesity (EO). Materials and methods The study included 110 men with general obesity. According to the results of echocardiography (ECG), patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT &lt;7 mm (n = 40) without diastolic dysfunction according to the results of ECG. All patients were assessed for sST2 and NT-pro-BNP levels using enzyme immunoassay. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus. Results In the group patients with EO ( + ) a statistically significant increase in the level of sST2 was revealed in comparison with the group of EO (-) [21,55 ng/ml (26,52; 15,40) and 9.89 ng/ml (11.12; 7.95); p = 0.001, respectively], while the levels of NT-pro-BNP in both groups were not statistically different [211.36 pg / ml (254.0; 156.0) and 204.81 pg / ml (268.0; 157.0), respectively, p = 0.85]. When determining the parameters of DD LV by ECG, there were no statistical differences between the EO (+) and EO (-) groups [e ", cm / sec 0.09 (0.11; 0.09) and 0.09 (0.11; 0.09), respectively, p = 0.63; E/e " , units, 7.80 (8.90; 6.55) in the EO (+) and 8.53 (9.70; 7.20) in the EO group ( - ), p = 0.08; left atrial volume index, ml / sq2, in the EO group (+) 28.39 (31.25; 24.17) and in the EO group(-) 27,82 (30,21; 25,66), p = 0.55; in the EO group ( + ), the maximum speed of tricuspid regurgitation, m / sec, is 2.78 (2.9; 2.58) in the EO group(-) 2,67 (2,87; 2,41), p = 0.13]. According to the results of speckle-tracking ECG in the EO (+) group, an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined in comparison with the EO ( - ) group (p = 0.03). A significant relationship between peak untwist ratio LV and sST2 was revealed (r = 0.37; p = 0.02). Conclusion Thus, it can be assumed that patients with EO have DD LV at the preclinical stage, which is not diagnosed using traditional ECG indicators. The serum biomarker sST2 is an early marker of the presence of HF.

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