scholarly journals Septal Flash Correction with His‐Purkinje Pacing Predicts Echocardiographic Response in Resynchronization Therapy

2022 ◽  
Author(s):  
Margarida Pujol‐López ◽  
Rafael Jiménez Arjona ◽  
Eduard Guasch ◽  
Adelina Doltra ◽  
Roger Borràs ◽  
...  
Keyword(s):  
Resynchronization Therapy ◽  
Septal Flash

P539Comparative analysis of patients with cardiac resynchronization therapy depending on septal flash

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
N Shirokov ◽  
V Kuznetsov ◽  
A Soldatova ◽  
L Malishevskii ◽  
D Krinochkin
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Interventricular Septum ◽  
Functional Class ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Basal Segment ◽  
Group I ◽  
Functional Features ◽  
Septal Flash

Abstract Background Mechanical dyssynchrony (MD) and superresponse (SR) to cardiac resynchronisation therapy (CRT) relationship is still debated. Aim To assess clinical and morpho-functional features of the heart in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT) depending on septal flash (SF). Materials and methods The study enrolled 60 patients (92.0% men, 8.0% women; mean age 54.5 ± 10.4 years; 70.0% had left bundle branch block (LBBB) with II-IV NYHA functional class CHF. SF (mechanical anomaly of interventricular septum (IVS) movement) is determined according to speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). Patients were divided into two groups: with SF (I group, n = 10) and without SF (II group, n = 50). Results At baseline the groups did not differ in main clinical characteristics including QRS width and LBBB. Mechanical interventricular delay was higher in group I (65.5 ms [53.5;95.5] vs 31.0 ms [15.0;64.5]; р=0.026). Basal segment of IVS longitudinal strain (LS) delay by STE (257.5 ms [156.3;293.8] vs 323.5 ms [262.5;377.8]; р=0.024) and LS delay by TDI (204.0 ms [170.8;260.3] vs 434.0 ms [370.0;489.0]; р<0.001) were significantly lower in group with SF. According to logistic regression a combination of LS apical segment of IVS by STE (HR 0.607; 95% Cl 0.369 – 0.989; р=0,048) and LS delay basal segment of IVS by TDI (HR 0.969; 95% Cl 0.0945 – 0.993; р=0.011) had a relationship with SF. According to ROC analysis sensitivity and specificity of this model in SF definition in patients with CRT were 87.5% and 86.5% (AUC = 0.939; p < 0.01). Mean changes in LV ESV (52.0 ml [32.5;72.8] vs 19,0 ml [1.3;40.0]; р=0.002) and LV ejection fraction (EF) (13.0% [5.5;18.8] vs 4.0% [2.0;9.0]; р=0.002) were significantly higher in patients with SF. All patients in group I had a super-response to CRT (ESV LV decrease ≥30%); 42.0% patients in group II were superresponders (р<0.001). Conclusion SF could be determined by STE and TDI. SF is associated with severe mechanical interventricular dyssynchrony and superresponse to CRT. Patients with SF have significantly better LV EF dynamics after CRT. Abstract Figure. Septal Flash in patient with SR to CRT

scholarly journals Relationship of septal flash with electromechanical dyssynchrony and super-response to cardiac resynchronization therapy

2020 ◽  
Vol 5 (2) ◽  
pp. 93-98
Author(s):  
Nikita E. Shirokov ◽  
Vadim A. Kuznetsov ◽  
Lev M. Malishevskii ◽  
Viktor V. Todosiichuk ◽  
Anna M. Soldatova ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Functional Class ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Group I ◽  
Relationship Of ◽  
Septal Flash

Objectives - to identify a relationship of septal flash (SF) with a super-response to cardiac resynchronization therapy (CRT), apical rocking (AR) and signs of left bundle brunch block (LBBB) in patients with congestive heart failure (CHF). Material and methods. The study included 38 patients (92.1% men; mean age 54.3±9.4 years) with II-IV NYHA functional class CHF. Left bundle brunch block (LBBB) was diagnosed according to 3 criteria: American Heart Association (AHA) 2009, European Society of Cardiology (ESC) 2013, Strauss. Septal flash (SF, mechanical anomaly of interventricular septum (IVS) movement) is determined according to speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). The patients were divided into two groups: with SF (I group, n=8) and without SF (II group, n=30). Mean follow-up was 34.5 [13.8;55.3]. Results. At baseline the groups did not differ in main clinical characteristics including QRS. The left ventricular (LV) ejection fraction (EF) was higher in group I (33.1%±1.7 and 30.0%±4.0; p=0.044). Basal segment of IVS longitudinal strain (LS) delay by STE (258.0 [144.0;294.0] ms vs 323.5 [273.3;385.0] ms; р=0.024) and LS delay by TDI (176.0 [146.8;287.3] ms vs 415.5 [315.8;493.5] ms; р30%); 53.1% of patients in group II were super responders (р

scholarly journals Comparative analysis of patients with cardiac resynchronization therapy depending on septal flash presence

2019 ◽  
pp. 44-53 ◽  
Author(s):  
N. E. Shirokov ◽  
V. A. Kuznetsov ◽  
A. M. Soldatova ◽  
D. V. Krinochkin ◽  
L. M. Malishevskii
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Interventricular Septum ◽  
Functional Class ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Basal Segment ◽  
Group I ◽  
Functional Features ◽  
Septal Flash

Aim. To assess clinical and morpho-functional features of the heart in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT) depending on septal flash (SF).Materials and methods. The study enrolled 60 patients (92.0% men, 8.0% women; mean age 54.5 ± 10.4 years; 70.0% had left bundle branch block (LBBB) with II-IV NYHA functional class CHF. SF (mechanical anomaly of interventricular septum (IVS) movement) is determined according to speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). Patients were divided into two groups: with SF (I group, n = 10) and without SF (II group, n = 50).Results. At baseline the groups did not differ in main clinical characteristics including QRS width and LBBB. Mechanical interventricular delay was higher in group I (65.5 ms [53.5; 95.5] vs 31.0 ms [15.0; 64.5]; р = 0.026). Basal segment of IVS longitudinal strain (LS) delay by STE (257.5 ms [156.3; 293.8] vs 323.5 ms [262.5; 377.8]; р = 0.024) and LS delay by TDI (204.0 ms [170.8; 260.3] vs 434.0 ms [370.0; 489.0]; р < 0.001) were significantly lower in group with SF. According to logistic regression a combination of LS apical segment of IVS by STE (HR 0.607; 95% Cl 0.369–0.989; р = 0.048) and LS delay basal segment of IVS by TDI (HR 0.969; 95% Cl 0.0945–0.993; р = 0.011) had a relationship with SF. According to ROC analysis sensitivity and specificity of this model in SF definition in patients with CRT were 87.5% and 86.5% (AUC = 0.939; p < 0.01). Mean changes in LV ESV (52.0 ml [32.5; 72.8] vs 19,0 ml [1.3; 40.0]; р = 0.002) and LV ejection fraction (EF) (13.0% [5.5; 18.8] vs 4.0% [2.0; 9.0]; р = 0.002) were significantly higher in patients with SF. All patients in group I had a superresponse to CRT (ESV LV decrease ≥30%); 42.0% patients in group II were superresponders (р < 0.001).Conclusion. SF could be determined by STE and TDI. SF is associated with severe mechanical interventricular dyssynchrony and superresponse to CRT. Patients with SF have significantly better LV EF dynamics after CRT. 

scholarly journals Septal flash as a predictor of cardiac resynchronization therapy response: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Sadie Bennett ◽  
Jacopoa Tafuro ◽  
Simon Duckett ◽  
Grant Heatlie ◽  
Ashish Patwala ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Resynchronization Therapy ◽  
Meta Analysis ◽  
Therapy Response ◽  
Symptomatic Improvement ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Septal Flash ◽  
Crt Response

Background: Cardiac resynchronization therapy (CRT) in heart failure patients has been shown to improve patient outcomes in some but not all patients. A few studies have identified that septal flash on imaging is associated with response to CRT but there has yet to be systematic review to evaluate consistency of the finding across the literature. Methods: A search of MEDLINE and EMBASE was conducted to identify studies which evaluate septal flash and its association with CRT response. Studies that met the inclusion criteria were statistically pooled with random-effects meta-analysis and heterogeneity was assessed using the I statistic. Results: A total of nine studies were included with 2,307 participants (mean age 76 years, 67% male). Septal flash on imaging before CRT implantation was seen in 53% of patients and the proportion of CRT responders from the included studies varied from 52% to 77%. In patients who were CRT responders, septal flash was seen in 40% of patients compared to 10% in those deemed to be CRT non-responders. Meta-analysis of the eight studies suggests that the presence of septal flash at pre-implant was associated with an increased likelihood of CRT response (RR 2.55 95%CI 2.04-3.19, p<0.001, I2=51%). Septal flash was also reported to be associated with left ventricular reverse remodelling but the association with survival and symptomatic improvement was less clear. Conclusions: Septal flash is a well-defined and distinctive contraction pattern which is consistently associated with CRT response and should be evaluated when assessing for appropriateness of CRT device.

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