Changes in left atrial size and function early after cardiac resynchronization therapy as assessed by conventional two-dimensional echocardiography

Aims: Cardiac resynchronization therapy (CRT) was shown to improve left atrial (LA) size and function within months after the procedure. We aimed to assess the impact of CRT on left atrial (LA) size and function within days after the procedure. Materials and methods: Twenty-eight consecutive patients with CRT were evaluated before the procedure and within 3 days afterwards, and 25 of them were also examined at three months. Echocardiography was performed to assess LA size and function: LA volumes indexed to body surface (LAVIs) were measured at different moments during the cardiac cycle: ventricular end-systole – maximum LAVI (LAVImax), before atrial systole (LAVIpreA), and at ventricular end-diastole – minimum LAVI (LAVImin). These measurements were further used to calculate LA function parameters: LA total emptying fraction, activeemptying fraction and passive emptying fraction.Results: LAVImax decreased within days after the procedure – 45.5 mL/ m2 (38.2-56.7) vs. 42.9 mL/m2 (32.1- 56.2), p <0.05, as did LAVImin – 27.1 mL/m2 (22.9-41.9) vs. 25.9 mL/m2 (17.8-38.1), p <0.05, and LAVIpreA – 40.0 mL/m2 (31.3-53.0) vs. 35.5 mL/m2 (25.8-49.1), without significant changes in functional parameters. All LAVIs were correlated to the diastolic filling time/RR interval ratio after CRT, but not before.Conclusions: LAVIs may be reduced within days after the implant procedure in responders to CRT, while atrial functional parameters remain unchanged. Correlations beween LAVIs and the diastolic filling time/RR interval ratio after CRT suggest that early optimization of atrio-ventricular and ventriculo-ventricular delays may have a positive and immediate impact on LA size.

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Echocardiographic evaluation of cardiac resynchronization therapy

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0612488p ◽

2006 ◽

Vol 134 (11-12) ◽

pp. 488-491 ◽

Cited By ~ 1

Author(s):

Milan Petrovic ◽

Goran Milasinovic ◽

Bosiljka Vujisic-Tesic ◽

Vera Jelic ◽

Zarko Calovic ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Diastolic Filling ◽

Lv Function ◽

Mitral Insufficiency ◽

Stroke Index ◽

Resynchronization Therapy ◽

Filling Time ◽

The Mean

Introduction: Cardiac resynchronization therapy (CRT) is relatively new tool in treatment of chronic heart failure (HF), especially in dilated cardiomyopathy (DCM) with the left bundle branch block (LBBB). Objective: The Objective of our study was to assess the success of CRT in treatment of severe HF and the role of echocardiography in the evaluation of Results of such therapy. Method: The group consisted of 19 patients, 13 males and 6 females, mean age 58.0?8.22 years (47-65 years) with CRT applied for DCM, severe HF (NYHA III-IV), LBBB and ejection fraction (EF) <35%. The mean follow up was 17 months (6.5-30). Standard color Doppler echocardiography examination was performed in all patients before and after CRT. The parameters of systolic and diastolic left ventricular function, mitral insufficiency and the right ventricular pressure were evaluated. Results: Following the CRT, statistically significant improvement of the end-systolic LV dimension, cardiac output, cardiac index, myocardial performance index (p<0.01) and stroke index (p<0.05) was recorded. The mean value of EFLV was increased by 10% and LV fractional shortening improved by 6% in 10/16 (62%) patients. CRT resulted in decreased MR (p<0.01), prolonged LV diastolic filling time (p<0.02) and reduced RV pressure (p<0.05). Interventricular mechanical delay was shortened by 28% (18 msec) Conclusion: CRT has an important role in improvement of LV function and correction of ventricular asynchrony. The echocardiography is a useful tool for evaluation of HF treatment with CRT.

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REVISITING DIASTOLIC FILLING TIME AS MECHANISTIC INSIGHT FOR RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60611-7 ◽

2013 ◽

Vol 61 (10) ◽

pp. E611

Author(s):

Frederik Hendrik Verbrugge ◽

David Verhaert ◽

Lars Grieten ◽

Matthias Dupont ◽

Maximo Rivero-Ayerza ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Cardiac Resynchronization ◽

Diastolic Filling ◽

Resynchronization Therapy ◽

Mechanistic Insight ◽

Filling Time

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Effect of Cardiac Resynchronization Therapy on Left Atrial Size and Function as Expressed by Speckle Tracking 2-Dimensional Strain

The American Journal of Cardiology ◽

10.1016/j.amjcard.2016.04.042 ◽

2016 ◽

Vol 118 (2) ◽

pp. 237-243 ◽

Cited By ~ 8

Author(s):

Cinzia Valzania ◽

Fredrik Gadler ◽

Giuseppe Boriani ◽

Claudio Rapezzi ◽

Maria J. Eriksson

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Atrial ◽

Speckle Tracking ◽

Cardiac Resynchronization ◽

Left Atrial Size ◽

Resynchronization Therapy ◽

Atrial Size ◽

And Function

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149 Acute effects on left ventricular systolic and diastolic function of a post-implant echocardiographic biventricular pacemaker optimization protocol following cardiac resynchronization therapy

European Heart Journal ◽

10.1093/ehjci/ehz872.006 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

P Barbier ◽

M Guglielmo ◽

C Agalbato ◽

I Viscone ◽

G Savioli

Keyword(s):

Cardiac Resynchronization Therapy ◽

Diastolic Function ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Diastolic Filling ◽

Acute Effects ◽

Resynchronization Therapy ◽

Biventricular Pacemaker ◽

Filling Time

Abstract Background Cardiac resynchronization therapy (CRT) has demonstrated efficacy in at least 60% of patients with left ventricular (LV) failure and guideline-based indication to CRT. Whereas lack of response to CRT in up to a third of patients is multifactorial, a relevant factor is thought to be inadequate biventricular pacemaker (BIV) optimization (OPT) of either the intraventricular (VVd) or atrioventricular (AVd) delay Purpose In this echocardiographic observational study, we compared the acute effects on LV contractility, output, and diastolic function of BIV intra-implant QRS duration-based (OPTq) and post-implant Doppler echocardiography-based (OPTe) OPT of VVd and AVd. Methods In 160 patients with ischemic (n = 86) or idiopathic (n = 74) dilated cardiomyopathy, guideline-based different de novo CRT systems were implanted followed by immediate OPTq. Post-implant (10 days) OPTe was performed measuring: transmitral velocity-time integral (MVFi), % diastolic filling time (MVFt%), and E/A ratio, LV outflow integral (LVOTi), ejection time (LVOTt), and stroke volume (SV), isovolumic contraction (IVCT) and relaxation (IVRT) times, and LV myocardial performance index (MPI). The protocol included, sequentially: 1) Doppler measurements with OPTq settings; 2) measurements (separated by 3’ intervals) during a range (80/200 ms) of AVd with synchronous VVd; 3) algorithm-based AVd selection (at least 2 of following: increase in MVFi or SV, decrease in MPI); 4) measurements, with set AVd, during range of VVd: LV-first (-20, -40ms); RV-first (20, 40ms); synchronous; 5) VVd selection based on same algorithm used for AVd selection. Results. At OPTq, 58.6% of patients were set synchronous, 38.6% LV-first and 3% RV-first, with a 126 ± 29 mean AVd. This increased to 137 ± 36 after OPTe, when 49.1% were set synchronous, 38% LV-first and 12.4% RV-first, resulting in modifications of AVd and VVd in 59% and 36% of patients. Further, gain in SV with OPTe, compared to OPTq, was 8.3% (p<.001), paralleled by an increase in MVFi (21.2 ± 8 cm vs 20.5 ± 8, p<.001) and decrease in E/A (1.25 vs 1.45, p<.001). The greatest increase in SV with OPTe was found in patients in whom both AVd and VVd were modified (n = 48; 81 ± 26 ml vs 71 ± 23, p<.001) vs. patients without modifications (n = 42), or with change of either AVd or VVd (n = 70; 77 ± 20 vs 72 ± 20, p<.01). Only in the first patient group both MVFi (22 ± 9 vs 20 ± 9, p<.001) and MVFt% (52 ± 7 vs 49 ± 8, p=.004) increased, along with a decrease in MPI (.82±.31 vs .92 ± 36, p=.007) and IVRT (144 ± 51 vs 156 ± 62, p=.02. Conclusions These preliminary results point to a significant incremental role of post-implant OPTe to enhance LV output, contractility, and diastolic function in patients with CRT. The prognostic role of OPTe-determined AVd and VVD changes remains to be determined.

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