Estimation of regional left ventricular wall stresses in intact canine hearts

1998 ◽  
Vol 275 (5) ◽  
pp. H1879-H1885 ◽  
Author(s):  
Abe DeAnda ◽  
Masashi Komeda ◽  
Marc R. Moon ◽  
G. Randall Green ◽  
Ann F. Bolger ◽  
...  
Keyword(s):  
High Speed ◽  
Systolic Function ◽  
Univariate Analysis ◽  
Interventricular Septum ◽  
Wall Stress ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Regional Wall ◽  
Inotropic State ◽  
Lv Systolic Function

Left ventricular (LV) wall stress is an important element in the assessment of LV systolic function; however, a reproducible technique to determine instantaneous local or regional wall stress has not been developed. Fourteen dogs underwent placement of twenty-six myocardial markers into the ventricle and septum. One week later, marker images were obtained using high-speed biplane videofluoroscopy under awake, sedated, atrially paced baseline conditions and after inotropic stimulation (calcium). With a model taking into account LV pressure, regional wall thickness, and meridional and circumferential regional radii of curvature, we computed average midwall stress for each of nine LV sites. Regional end-systolic and maximal LV wall stress were heterogeneous and dependent on latitude (increasing from apex to base, P < 0.001) and specific wall (anterior > lateral and posterior wall stresses; P = 0.002). Multivariate ANOVA demonstrated only a trend ( P = 0.056) toward increased LV stress after calcium infusion; subsequent univariate analysis isolated significant increases in end-systolic LV wall stress with increased inotropic state at all sites except the equatorial regions. The model used in this analysis incorporates local geometric factors and provides a reasonable estimate of regional LV wall stress compared with previous studies. LV wall stress is heterogeneous and dependent on the particular LV site of interest. Variation in wall stress may be caused by anatomic differences and/or extrinsic interactions between LV sites, i.e., influences of the papillary muscles and the interventricular septum.

scholarly journals The impact of obesity on left ventricular mass and left ventricular systolic function in children

2016 ◽  
Vol 45 (4) ◽  
pp. 171
Author(s):  
Ria Nova ◽  
Bambang Madiyono ◽  
Sudigdo Sastroasmoro ◽  
Damayanti R Sjarif
Keyword(s):  
Wall Thickness ◽  
Systolic Function ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Internal Diameter ◽  
Obese Children ◽  
Normal Children ◽  
Posterior Wall Thickness ◽  
Lv Mass ◽  
Lv Systolic Function

Background Obesity causes cardiovascular disturbances. Theincidence of cardiovascular disease is higher even in mildly obesepatients than in lean subjects.Objectives The purpose of this study was to compare left ven-tricular (LV) mass, LV internal dimensions, and LV systolic func-tion between obese and normal children; and to determine the as-sociation of the degree of obesity with LV mass and LV systolicfunction.Methods This cross-sectional study was conducted on elemen-tary school students in Jakarta from February to April 2003. Wemeasured the subjects’ body weight and height, and performedlipid profile and echocardiography examinations. Measurementsof LV mass, LV internal dimensions with regard to septum thick-ness, LV internal diameter, and LV posterior wall thickness; andLV systolic function as indicated by shortening fraction and ejec-tion fraction, were performed echocardiographically. The differ-ences in measurements between obese and normal children aswell as between obese children with and without lipid abnormalitywere analyzed. The correlation between the degree of obesity withLV size and systolic function was determined.Results Twenty-eight normal children and 62 obese children wereenrolled in the study. Mean LV mass was 35.7 (SD 5.16) g/cm 3 inobese children versus 24.0 (SD 3.80) g/cm 3 in normal children(P<0.0001). Mean septum thickness was 0.8 (SD 0.14) mm inobese children versus 0.6 (SD 7.90) mm in normal children (P<0.0001). Mean posterior wall thickness was 0.9 (SD 0.14) mm inobese children versus 0.6 (SD 9.97) mm in normal children(P<0.0001). Mean LV internal diameter was 4.0 (SD 0.34) mm inobese children versus 3.9 (SD 0.29) mm in normal children(P=0.300). There was strong correlation between the degree ofobesity and LV mass (r=0.838, P<0.0001). LV systolic function(shortening fraction) was 37.1 (SD 4.20) percent in obese childrenversus 35.8 (SD 4.99) percent in normal children (P=0.19). Ejec-tion fraction was 67.4 (SD 5.32) percent in obese children versus65.5 (SD 6.29) percent in normal children (P=0.13). There wasweak correlation between LV systolic function and the degree ofobesity (shortening fraction r=0.219, P=0.038; ejection fractionr=0.239, P=0.023).Conclusions Obese children had significantly greater LV mass,septum thickness, and posterior wall thickness than normal chil-Backgrounddren. Such significant difference was absent for LV internal diam-eter and measures of LV systolic function. There was no signifi-cant difference in LV mass and LV systolic function between obesechildren with or without abnormality of lipid profile. A strong corre-lation exists between the degree of obesity and LV mass, but thecorrelation between degree of obesity and LV systolic function wasweak

scholarly journals Correlation between hemoglobin level and left ventricular systolic functions and dimensions in children with chronic severe anemia

2011 ◽  
Vol 51 (2) ◽  
pp. 79
Author(s):  
Erlina Masniari Napitupulu ◽  
Fera Wahyuni ◽  
Tina Christina L. Tobing ◽  
Muhammad Ali ◽  
Bidasari Lubis
Keyword(s):  
Systolic Function ◽  
Pearson Correlation ◽  
Systolic Dysfunction ◽  
Univariate Analysis ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Severe Anemia ◽  
Cross Sectional ◽  
Lv Systolic Function

Background Chronic severe anemia is a connnon disease. Cardiac output may increase when the hemoglobin (Hb) level decreases to < 7 g/dL for 3 months or more. Alteration of left ventricular (LV) function occurs frequently in children 'With chronic severe anemia, in the {onn of concentric LV hypertrophy, LV dilatation with or v.ithout LV hypertrophy, or systolic dysfunction. Objective To examine the correlation between Hb level and alteration of LV systolic function in children with chronic severe anemia. Methods We conducted a cross-sectional study in Adam Malik Hospital from October to December 2009. Subjects were chronic severely anemic children. Left ventricular systolic function (ejection fraction/EF, fractional shortening/FS) and dimensions (left ventricular end diastolic diameter/LVEDD and left ventricular end systolic diameter/LVESD) were measured using Hitachi EUB 5500 echocardiography unit. Univariate analysis  and Pearson correlation were performed.Results Thirty children were enrolled in the study. The mean of age was 113.5 months (SD 53.24). Hb values ranged from 2.1 to 6.9 g/dL with mean value of 4.6 g/dL (SD 1.44). Mean duration of anemia was 3.9 months (SD 0.70). Chronic severe anemia was not associated \\lith decreased LV systolic function [EF 62.2% (SD 9.16), r =0.296, P=0.112; FS 33.8% (SD 7.26), r =0.115, P=0.545], nor LV dimension changes [LVEDD 40.2 mm (SD 6.85), r = -0.192, P=0.308; LVESD 26.2 mm (SD 4.98), r=-0.266, P=0.156]. Conclusion There was no correlation between Hb level in chronically anemic children and changes in LV systolic function or dimension.

Complete dexrazoxane cardioprotection for cardiac function but incomplete female cardioprotection for cardiac structure in doxorubicin-treated osteosarcoma survivors: Hearts too small for the body.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10519-10519
Author(s):  
Lisa M. Kopp ◽  
Mark L. Bernstein ◽  
Cindy L. Schwartz ◽  
David Ebb ◽  
Vivian L Franco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Wall Thickness ◽  
Systolic Function ◽  
Posterior Wall ◽  
Left Ventricular ◽  
The Body ◽  
Lv Function ◽  
Lv Systolic Function ◽  
Trastuzumab Cardiotoxicity

10519 Background: Dexrazoxane is protective for lower-dose doxorubicin ( < 300 mg/m2) cardiotoxicity in childhood cancer, but the effect of dexrazoxane (DXRZ) administered with higher-dose (HD) doxorubicin (DOXO) is unknown. Methods: We evaluated patients from Children’s Oncology Group trials for localized (P9754) and metastatic (AOST0121) osteosarcoma (OS) who received HD DOXO (375-600 mg/m2) preceded by DXRZ (10:1 ratio), methotrexate, and cisplatin; some also received ifosfamide alone or ifosfamide/etoposide ± trastuzumab. Cardiotoxicity was identified by echocardiography and by serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations. Results: 81 DXRZ -treated OS patients ( age at enrollment = 13.7 years; range 3.8 - 23.7 years) had normal left ventricular (LV) systolic function as measured by LV fractional shortening and no heart failure. Female sex and longer follow-up since DOXO were associated with a significantly smaller LV dimension z-score normalized to BSA (μ = -1.20, 95%CI [-1.70, -0.70]). Similarly, in the one-third of patients treated > 81 days after minimal expected treatment (groups equally partitioned by time), significantly thinner LV posterior wall thickness for BSA (μ = -0.57, [-1.05, -0.09]) was found. Interventricular septal wall thickness (μ = -0.84, [-1.2, -0.48]) and LV mass (μ = -0.73, [-1.06, -0.40]) were significantly smaller for BSA than normal for both sexes. For females, these became significantly more abnormal with increasing length of follow-up. Females also showed progressive increases in NT-proBNP. Conclusions: DXRZ is cardioprotective for HD DOXO in terms of LV function and heart failure. Females had progressive abnormalities of LV structure, leading to smaller hearts for body size. This was associated with increasing cardiac stress, as measured by NT-proBNP. DXRZ protection was incomplete for HD DOXO effects on LV structure, resulting in higher LV stress and risk for late LV dysfunction. DXRZ should continue to be used in this population, including for females who exhibit more cardiotoxicity than males at specific cumulative DOXO doses.

Adaptations in β-adrenergic cardiovascular responses to training in older women

2000 ◽  
Vol 89 (6) ◽  
pp. 2300-2305 ◽  
Author(s):  
Robert J. Spina ◽  
Saima Rashid ◽  
Victor G. Dávila-Román ◽  
Ali A. Ehsani
Keyword(s):  
Exercise Training ◽  
Older Women ◽  
Contractile Function ◽  
Systolic Function ◽  
Wall Stress ◽  
Cardiovascular Responses ◽  
Left Ventricular ◽  
Lv Function ◽  
Lv Systolic Function ◽  
Systolic Wall Stress

To determine whether endurance exercise training can alter the β-adrenergic-stimulated inotropic response in older women, we studied 10 postmenopausal healthy women (65.4 ± 0.9 yr old) who exercised for 11 mo. Left ventricular (LV) function was evaluated with two-dimensional echocardiography during infusion of isoproterenol after atropine. Maximal O2 consumption increased 23% in response to training (from 1.35 ± 0.06 to 1.66 ± 0.07 l/min; P = 0.004). Training had no effect on baseline LV function, end-diastolic diameter, LV wall thickness, or LV mass. The increase in LV systolic function in response to isoproterenol was unaffected by training. Furthermore, neither the systolic shortening-to-end-systolic wall stress relationship nor the end-systolic wall stress-to-end-systolic diameter relationship during isoproterenol infusion changed with training. We conclude that older postmenopausal women can increase their maximal O2consumption with exercise training without eccentric LV hypertrophy or enhancement of β-adrenergic-mediated LV contractile function. These observations provide an explanation for the finding that maximal cardiac output and stroke volume are not increased in older women in response to training.

scholarly journals Association of Inadequately Low Left Ventricular Mass with Enhanced Myocardial Contractility in Severe Degenerative Aortic Stenosis

2018 ◽  
Vol 7 (12) ◽  
pp. 464 ◽  
Author(s):  
Bernadeta Chyrchel ◽  
Dorota Długosz ◽  
Klaudiusz Bolt ◽  
Olga Kruszelnicka ◽  
Artur Dziewierz ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Wall Stress ◽  
Left Ventricular ◽  
Lv Mass ◽  
Hemodynamic Characteristics ◽  
Stenosis Severity ◽  
Lv Systolic Function ◽  
The Individual

Background: Left ventricular hypertrophy (LVH), traditionally considered an adaptive mechanism that is aimed at the maintenance of LV systolic function, is absent in 10%–35% of patients with severe aortic stenosis (AS). Our aim was to estimate the clinical and hemodynamic characteristics in patients with severe AS and absent LVH, or inadequately low LV mass (i-lowLVM) relative to an individual hemodynamic load. Methods: We retrospectively analyzed in-hospital records of 100 patients with pure severe degenerative AS, preserved LV systolic function and without relevant coexistent diseases, except for well-controlled hypertension or diabetes. Results: Clinical characteristics were similar in patients with and without LVH, as well as those with and without i-lowLVM, except for slightly lower GFR at i-lowLVM. When compared to their counterparts, subjects without LVH or with i-lowLVM had smaller LV cavities, decreased LV wall thicknesses and higher EF. There were no significant differences in stenosis severity and indices of afterload (valvulo-arterial impedance and circumferential end-systolic LV wall stress), according to the presence or absence of either LVH or i-lowLVM. However, LV fractional shortening at the midwall level was elevated only in patients with i-lowLVM, but not in those without LVH, compared to the remainder (15.8 ± 3.3 vs. 12.9 ± 3.2%, p < 0.001 for those with and without i-lowLVM, respectively; 13.7 ± 3.7 vs. 13.8 ± 3.6% for LVH presence and absence, p = 0.9). Conclusions: Inadequately low LVM relative to the individual hemodynamic load could potentially reflect a different mode of the LV response to severe AS, associated with enhanced load-independent LV systolic performance, i.e., better LV contractility. If confirmed in a large series of patients, our small preliminary study may add to the possible mechanisms of a previously reported counterintuitive tendency of a lower, not higher, risk of adverse outcome in patients with low LV mass despite severe AS. Prospective studies are warranted, in order to determine a potential utility of LVM inadequacy in the risk stratification of patients with AS.

scholarly journals P1514 Increased myocardial oxygen demand is associated with impaired left ventricular strain in patients with morbid obesity referred for bariatric surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L M Grymyr ◽  
S Nadirpour ◽  
E Gerdts ◽  
B G Nedreboe ◽  
J J Hjertaas ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Pulse Pressure ◽  
Systolic Function ◽  
Oxygen Demand ◽  
Wall Stress ◽  
Left Ventricular ◽  
Myocardial Oxygen Demand ◽  
Lv Mass ◽  
Obese Subjects ◽  
Lv Systolic Function

Abstract Background Obesity predisposes for left ventricular (LV) hypertrophy and systolic dysfunction. Higher myocardial oxygen demand in LV hypertrophy is associated with higher risk for cardiovascular events, while the association with LV systolic function has been less explored. Purpose To assess the association of myocardial oxygen demand with LV systolic function in morbidly obese subjects without known heart disease. Methods Clinical and echocardiographic data from 110 obese subjects referred for gastric bypass surgery (mean age 42 ± 11 years, 74% women, mean body mass index [BMI] 41.9 ± 4.8 kg/m², 33% with hypertension, 15% with diabetes) in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study was used. LV function was assessed by ejection fraction (EF) by Simpson"s biplane method and endocardial global longitudinal strain (GLS) by 2D vector velocity imaging using a 16-segment model (Image Arena 4.6, Tomtec, Unterschleissheim, Germany). Myocardial oxygen demand was estimated from LV mass - wall stress - heart rate product according to a previously validated formula. Results Myocardial oxygen demand was higher in men (1884 vs. 1579 x 10³ g x kdyne/cm² x bpm, p &lt; 0.05), and associated with higher BMI (r = 0.24) and pulse pressure (r = 0.28), and with lower EF (r = -0.22) and lower GLS (r = 0.26, all p &lt; 0.05). In multiple regression analysis, higher myocardial oxygen demand was associated with lower LV GLS (Beta = 0.21, p &lt; 0.05) independent of age, gender, BMI, pulse pressure, diabetes, and EF (Table). Conclusion In obese patients without known heart disease referred for bariatric surgery, higher myocardial oxygen demand was associated with lower LV systolic function measured by GLS independent of confounders. Covariates of lower GLS in multivariable Variable β correlation coefficient p LV mass - wall stress - heart rate product (g x kdyne/cm&sup2; x bpm x 10&sup3;) 0.21 0.04 Age (years) -0.12 0.22 Gender 0.34 &lt;0.01 BMI (kg/m&sup2;) 0.25 &lt;0.01 Pulse pressure (mmHg) -0.04 0.71 Diabetes -0.17 0.09 LV EF (%) -0.01 0.90

P3441Impact of maternal preeclampsia on left ventricular structure and function in the newborn heart

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R O B Voegg ◽  
J Ghouse ◽  
A S Sillesen ◽  
C A Pihl ◽  
A Axelsson Raja ◽  
...  
Keyword(s):  
Systolic Function ◽  
Interventricular Septum ◽  
Posterior Wall ◽  
Population Based ◽  
Left Ventricular ◽  
P Value ◽  
Internal Diameter ◽  
Increased Risk ◽  
And Function ◽  
Fractional Shortening

Abstract Background Maternal preeclampsia (PE) has been associated with an increased risk of a variety of congenital heart defects in the infant. Whether PE also confers an increased risk of subtle structural and functional cardiac deficits is unknown. Purpose We investigated whether left ventricular dimensions and systolic function differed among infants of mothers with PE, compared to infants born after uncomplicated pregnancies. Method Systematic transthoracic echocardiography (TTE) was performed in neonates included in a population-based study in the period 2016–2018 (n=25,000). TTE was preferably performed within 14 days of birth. Left ventricular (LV) posterior wall end-diastolic thickness (LVPWd), interventricular septum end-diastole thickness (IVSd), LV internal diameter in end-diastole and end-systole (LVIDd and LVIDs), LV ejection fraction (LVEF) and fractional shortening (FS) were assessed. Information on maternal PE (ICD-10 codes DO140–142 and DO159) was retrieved from an obstetric database. Using linear regression in a sample of echocardiograms, we compared the LV structure and function adjusted for maternal age; gestational age; sex; weight and length. Results In total, 447 infants were exposed to PE, and 7,178 were born to uncomplicated pregnancies (Table). In infants of PE mothers, we found significantly larger LVPWd and IVSd (0.18 mm, 95% CI [0.14; 0.22], p<0.001 and 0.06 mm, 95% CI [0.02; 0.10], p=0.001, resp.) and LVIDd as LVIDs were significantly smaller (−0.15 mm, 95% CI [−0.29; −0.01], p=0.032 and −0.16 mm 95% CI [−0.28; −0.04], p=0.009, resp.) compared to infants of non-PE mothers. We found no differences in systolic function. LV measures in PE and non-PE infants Parameter Infants of PE mothers, Infants of non-PE mothers, p-value Estimate* [95% CI] p-value mean [± SD] (n=447) mean [± SD] (n=7,178) Left Ventricular Posterior Wall in end-Diastole, LVPWd (mm) 2.20 [±0.58] 2.07 [±0.40] <0.001 0.18 [0.14; 0.22] <0.001 Interventricular Septum in end-Diastole, IVSd (mm) 2.53 [±0.52] 2.55 [±0.41] 0.562 0.06 [0.02; 0.10] 0.001 Left Ventricular Internal Diameter in end-Diastole, LVIDd (mm) 19.35 [±2.00] 20.10 [±1.41] <0.001 −0.15 [−0.29; −0.01] 0.032 Left Ventricular Internal Diameter in end-Diastole, LVIDs (mm) 13.13 [±1.43] 13.65 [±1.79] <0.001 −0.16 [−0.28; −0.04] 0.009 Fractional Shortening, FS (%) 32.10 [±4.07] 32.11 [±3.86] 0.937 0.26 [−0.11; 0.63] 0.168 Left Ventricular Ejection Fraction, LVEF (%) 63.19 [±5.61] 63.09 [±5.30] 0.690 0.34 [−0.17; 0.85] 0.192 *Adjusted for maternal age; gestational age; sex; weight and length. Conclusion In the largest population-based group of neonates to date, we showed that infants born to PE mothers compared to infants of non-PE mothers had significantly thicker left ventricular myocardium, and reduced left ventricular volumes. However, PE was not associated with altered systolic function. Our results might reflect an adaption of the fetal heart to the increased resistance in the placental arteries in PE mothers, and a secondary increased left ventricular afterload. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Lundbeck Found.

scholarly journals Association between Neonatal Intakes and Hyperglycemia, and Left Heart and Aortic Dimensions at 6.5 Years of Age in Children Born Extremely Preterm

2021 ◽  
Vol 10 (12) ◽  
pp. 2554
Author(s):  
Jawwad Hamayun ◽  
Lilly-Ann Mohlkert ◽  
Elisabeth Stoltz Sjöström ◽  
Magnus Domellöf ◽  
Mikael Norman ◽  
...  
Keyword(s):  
Interventricular Septum ◽  
Posterior Wall ◽  
Root Diameter ◽  
Left Ventricular ◽  
Left Heart ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Nutritional Data ◽  
Aortic Dimensions

Survivors of extremely preterm birth (gestational age < 27 weeks) have been reported to exhibit an altered cardiovascular phenotype in childhood. The mechanisms are unknown. We investigated associations between postnatal nutritional intakes and hyperglycemia, and left heart and aortic dimensions in children born extremely preterm. Postnatal nutritional data and echocardiographic dimensions at 6.5 years of age were extracted from a sub-cohort of the Extremely Preterm Infants in Sweden Study (EXPRESS; children born extremely preterm between 2004–2007, n = 171, mean (SD) birth weight = 784 (165) grams). Associations between macronutrient intakes or number of days with hyperglycemia (blood glucose > 8 mmol/L) in the neonatal period (exposure) and left heart and aortic dimensions at follow-up (outcome) were investigated. Neonatal protein intake was not associated with the outcomes, whereas higher lipid intake was significantly associated with larger aortic root diameter (B = 0.040, p = 0.009). Higher neonatal carbohydrate intake was associated with smaller aorta annulus diameter (B = −0.016, p = 0.008). Longer exposure to neonatal hyperglycemia was associated with increased thickness of the left ventricular posterior wall (B = 0.004, p = 0.008) and interventricular septum (B = 0.004, p = 0.010). The findings in this study indicate that postnatal nutrition and hyperglycemia may play a role in some but not all long-lasting developmental adaptations of the cardiovascular system in children born extremely preterm.

scholarly journals Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

2021 ◽  
Author(s):  
Philippe C. Wouters ◽  
Geert E. Leenders ◽  
Maarten J. Cramer ◽  
Mathias Meine ◽  
Frits W. Prinzen ◽  
...  
Keyword(s):  
Systolic Function ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Lv Function ◽  
Peak Strain ◽  
Cardiac Resynchronisation ◽  
Reverse Remodelling ◽  
Resynchronisation Therapy ◽  
Lv Systolic Function

AbstractPurpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

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