Merits of Different Ventricular Lead Locations on Left Ventricular Myocardial Strain and Dyssynchrony in Patients with Cardiac Resynchronization Therapy

Cardiology ◽  
2019 ◽  
Vol 145 (1) ◽  
pp. 13-20
Author(s):  
Alaa S. Algazzar ◽  
Mohamed M. Elbably ◽  
Azza A. Katta ◽  
Neama  Elmeligy ◽  
Khaled Elrabbat ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Circumferential Strain ◽  
Nyha Class ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Short Term

Background: The idea behind cardiac resynchronization therapy (CRT) is to pace both ventricles resulting in a synchronized electro-mechanical coupling of the left ventricle (LV), meaning every effort should be made to improve the percentage of CRT responders. Objectives: This study aimed at demonstrating the short-term effect of right ventricular apical (RVA) and mid-septal (RVS) lead locations combined with different LV lead positions on LV myocardial strain, dyssynchrony, and clinical outcomes. Methods: We examined 60 patients with indication for CRT before and after 6 months of implantation for clinical outcome and CRT response (6-min walk test [6MWT], NYHA class, decrease in left ventricular end systolic volume [LVESV] by >15%), dyssynchrony, and myocardial strain. Results: After 6 months of follow-up, the two RV lead locations represented a significant improvement in 6MWT, left ventricular ejection fraction, and LVESV in comparison to baseline values, but no significant difference was found between both groups. With regards to NYHA class improvement, p values were insignificant between the groups (0.44 and 0.88) at baseline and 6 months after implantation, respectively. The mean 6MWT was 273.8 m in the RVA group compared to 279.0 m in the RVS group (p = 0.84) at baseline. After 6 months of CRT implantation, the 6MWT mean was 326.5 m in the RVA group compared to 316.2 m in the RVS group (p = 0.74). The posterolateral cardiac vein site showed a significant improvement when combined with RVS location in interventricular and intraventricular dyssynchrony, global longitudinal strain, global circumferential strain, and apical circumferential strain (p = 0.01 0.032, 0.02, 0.005, and 0.049), respectively. Conclusion: RVS is not inferior and provides a good alternative to RVA pacing in short-term follow-up. However, the QRS duration, myocardial strain, and dyssynchrony varies depending on RV and LV stimulation sites. Long-term morbidity and mortality outcomes according to LV lead location in coronary sinus need more assessment.

P1240Is resynchronization therapy really efficient in laminopathy?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Burdeau ◽  
G Viart ◽  
E Gandjbakhch ◽  
A Savoure ◽  
B Godin ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Heart Transplantation ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction

Abstract Introduction Laminopathy (LMNA) is a group of rare disease caused by a mutation of lamin A/C genes. Heart transplantation (HT) is often required. Cardiac resynchronization therapy (CRT) may be an option to postpone HT. Purpose To describe characteristics and outcome of LMNA patients receiving CRT. Methods All consecutive LMNA patients implanted with a CRT device for conventional indications were included in the study. Clinical and echocardiographic (TTE) data were collected during the follow-up period. Results From 2002 to 2017, 68 LMNA patients had CRT implantation. Despite CRT, 30/68 patients (44%) had HT. Population divided into two groups according to response to CRT. Patients were considered without benefit (WHOB-CRT group) if they experienced severe events (inscription on heart transplantation list or death) within two years after CRT implantation. Other patients were in the WB-CRT group. TTE and clinical parameters are described in Table 1. Table 1 Parameters WB-CRT (n=33) WHOB-CRT (n=35) P-value At implantation   Age (years) 52.3±9.7 50.6±9.5 0.27   Women 9 (27%) 13 (37%) 0.45   NYHA class 2.7±0.6 2.8±0.7 0.45   LVEF (%) 33.2±8.8 31.3±7 0.64   LVEDD (mm) 60±6.9 60±6.9 0.96   TAPSE (mm) 23±3.7 14±4.8 0.002 At last follow up   NYHA class 2.2±0.6 2.9±0.7 <0.001   LVEF (%) 36.4±11 27±9 <0.001   LVEDD (mm) 59±5.5 59±7.7 0.98   TAPSE (mm) 19.9±5.5 12.3±3.3 0.003 Left ventricular ejection fraction (LVEF); Left ventricular end diastolic diameter (LVEDD); Tricuspid annular plane systolic excursion (TAPSE). Conclusion Cardiac resynchronization therapy is less efficient in LMNA patients. An impaired right ventricular stroke function seems to be the only predictive factor leading to poor response to CRT.

scholarly journals Prediction of 5-year survival in patients with heart failure and implanted cardiac resynchronization therapy devices

2021 ◽  
Vol 26 (6) ◽  
pp. 4409
Author(s):  
A. M. Soldatova ◽  
V. A. Kuznetsov ◽  
E. A. Gorbatenko ◽  
T. N. Enina ◽  
L. M. Malishevsky
Keyword(s):  
Heart Failure ◽  
Survival Rate ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Training Sample ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Aim. Based on clinical parameters and diagnostic investigations, to create a complex model of personalized selection of patients with heart failure (HF) for cardiac resynchronization therapy (CRT). To establish the diagnostic value of the created model in predicting 5-year survival.Material and methods. The study included 141 patients with HF (men, 77,3%; women, 22,7%). The mean age of patients at the time of implantation was 60,0 [53,0; 66,0] years. All patients had New York Heart Association (NYHA) class II-IV HF, left ventricular ejection fraction (LVEF) ≤35%, and QRS ≥130 ms. Patients were randomly divided into training (n=95) and test (n=36) samples, which were comparable in main clinical and functional characteristics.Results. The index included parameters that had a significant relationship with 5-year survival according to the Cox regression: male sex, prior myocardial infarction, hypertension, QRS <150 ms, no left bundle branch block, PR ≥200 ms with sinus rhythm/absence of radiofrequency ablation in atrial fibrillation, NYHA class III, IV HF, LVEF <30%, left ventricular end-diastolic volume ≥235,0 ml, NT-proBNP ≥2692,0 ng/ml. All variables were scored based on the в-coefficients. In the training sample, a value ≥45 points demonstrated a sensitivity of 82,4% and a specificity of 67,2% in predicting 5-year survival (AUC, 0,873; p<0,001). The index use on the test sample showed comparable results (AUC, 0,718; p=0,020; sensitivity — 71,4%, specificity — 62,5%). Also, in the training sample, the index ≥45 points was associated with1-year survival (sensitivity — 84,6%, specificity — 58,1%, AUC, 0,811; p<0,001).Conclusion. An index of personalized selection for CRT has been created, which makes it possible to accurately predict the 5-year survival rate, as well as the 1-year survival rate, regardless of the current selection criteria.

Feasibility and efficacy of left bundle branch area pacing in patients indicated for cardiac resynchronization therapy

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii54-ii60
Author(s):  
Yuqiu Li ◽  
Lirong Yan ◽  
Yan Dai ◽  
Yu’an Zhou ◽  
Qi Sun ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction ◽  
Intraventricular Conduction ◽  
Lead Placement

Abstract Aims The present study was to evaluate the feasibility and clinical outcomes of left bundle branch area pacing (LBBAP) in cardiac resynchronization therapy (CRT)-indicated patients. Methods and results LBBAP was performed via transventricular septal approach in 25 patients as a rescue strategy in 5 patients with failed left ventricular (LV) lead placement and as a primary strategy in the remaining 20 patients. Pacing parameters, procedural characteristics, electrocardiographic, and echocardiographic data were assessed at implantation and follow-up. Of 25 enrolled CRT-indicated patients, 14 had left bundle branch block (LBBB, 56.0%), 3 right bundle branch block (RBBB, 12.0%), 4 intraventricular conduction delay (IVCD, 16.0%), and 4 ventricular pacing dependence (16.0%). The QRS duration (QRSd) was significantly shortened by LBBAP (intrinsic 163.6 ± 29.4 ms vs. LBBAP 123.0 ± 10.8 ms, P &lt; 0.001). During the mean follow-up of 9.1 months, New York Heart Association functional class was improved to 1.4 ± 0.6 from baseline 2.6 ± 0.6 (P &lt; 0.001), left ventricular ejection fraction (LVEF) increased to 46.9 ± 10.2% from baseline 35.2 ± 7.0% (P &lt; 0.001), and LV end-diastolic dimensions (LVEDD) decreased to 56.8 ± 9.7 mm from baseline 64.1 ± 9.9 mm (P &lt; 0.001). There was a significant improvement (34.1 ± 7.4% vs. 50.0 ± 12.2%, P &lt; 0.001) in LVEF in patients with LBBB. Conclusion The present study demonstrates the clinical feasibility of LBBAP in CRT-indicated patients. Left bundle branch area pacing generated narrow QRSd and led to reversal remodelling of LV with improvement in cardiac function. LBBAP may be an alternative to CRT in patients with failure of LV lead placement and a first-line option in selected patients such as those with LBBB and heart failure.

scholarly journals Sex-Specific Patterns of Mortality Predictors Among Patients Undergoing Cardiac Resynchronization Therapy: A Machine Learning Approach

2021 ◽  
Vol 8 ◽  
Author(s):  
Márton Tokodi ◽  
Anett Behon ◽  
Eperke Dóra Merkel ◽  
Attila Kovács ◽  
Zoltán Tősér ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Conditional Inference ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
All Cause Mortality ◽  
Test Sets

Background: The relative importance of variables explaining sex-related differences in outcomes is scarcely explored in patients undergoing cardiac resynchronization therapy (CRT). We sought to implement and evaluate machine learning (ML) algorithms for the prediction of 1- and 3-year all-cause mortality in CRT patients. We also aimed to assess the sex-specific differences in predictors of mortality utilizing ML.Methods: Using a retrospective registry of 2,191 CRT patients, ML models were implemented in 6 partially overlapping patient subsets (all patients, females, or males with 1- or 3-year follow-up). Each cohort was randomly split into training (80%) and test sets (20%). After hyperparameter tuning in the training sets, the best performing algorithm was evaluated in the test sets. Model discrimination was quantified using the area under the receiver-operating characteristic curves (AUC). The most important predictors were identified using the permutation feature importances method.Results: Conditional inference random forest exhibited the best performance with AUCs of 0.728 (0.645–0.802) and 0.732 (0.681–0.784) for the prediction of 1- and 3-year mortality, respectively. Etiology of heart failure, NYHA class, left ventricular ejection fraction, and QRS morphology had higher predictive power, whereas hemoglobin was less important in females compared to males. The importance of atrial fibrillation and age increased, while the importance of serum creatinine decreased from 1- to 3-year follow-up in both sexes.Conclusions: Using ML techniques in combination with easily obtainable clinical features, our models effectively predicted 1- and 3-year all-cause mortality in CRT patients. Sex-specific patterns of predictors were identified, showing a dynamic variation over time.

P3807Impact of unipolar vs bipolar left ventricular pacing using a quadripolar lead on heart failure hospitalization in patients undergoing cardiac resynchronization therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mittal ◽  
T Stivland ◽  
N Wold ◽  
E Hammill ◽  
K M Stein
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Study Cohort ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization ◽  
Lead Location

Abstract Background Unipolar (uni) pacing from a bipolar left ventricular (LV) pacing lead in cardiac resynchronization therapy (CRT) patients (pts) has been associated with worse outcomes than bipolar (bi) pacing (MADIT CRT and ALTITUDE analyses). However, it is unknown whether the same is true with quadripolar LV pacing leads. Purpose To determine whether there is a difference in heart failure hospitalization (HFH) following CRT implantation in pts undergoing uni vs. bi LV pacing. Methods All pts enrolled in the NAVIGATE study were implanted with a CRT-D (RESONATE, Boston Scientific) using a quadripolar LV lead (ACUITY X4 Spiral Long, Spiral Short, or Straight). Pts were followed, and data collected on HFH and mortality. Vectors were programmed at the discretion of the implanter. Outcomes were adjusted for age, gender, NYHA class, ischemic etiology, conduction disorder pattern, EF, LV lead location, and LV lead shape. Results The study cohort included 2080 pts; 1781 pts had bi and 299 pts had uni LV pacing. Bi LV had higher % female, NYHA II/III, non-ischemic, LBBB, spiral shape, lateral and apical locations. During follow-up, the adjusted likelihood of HFH was significantly lower in pts undergoing bi LV pacing (HR 0.75, 0.58–0.97, p=0.027, Figure). Mortality was similar between the two groups. Conclusions In this large prospective study, uni LV pacing was associated with significantly greater likelihood of need for HFH during a 4-year follow-up period. These data suggest that routine programming in a bi configuration may be better for post-CRT pts. However, further study is needed to confirm causality and mechanism of this finding.

P1174Impact of sex-differences in long-term outcomes with cardiac resynchronization therapy: are women different?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Z L Moreno Weidmann ◽  
C Alonso-Martin ◽  
F Mendez-Zurita ◽  
E Rodriguez-Font ◽  
J Guerra-Ramos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Nyha Class ◽  
Real Life ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
The Moment

Abstract Introduction Women are frequently underrepresented in clinical trials for heart failure. Differences on cardiovascular background may imply differences on indications, device election and outcomes in patients receiving cardiac devices (CRT and ICD). We sought to compare sex-related differences in a real-life cohort. Methods We analyzed all subjects who underwent a cardiac resynchronization therapy (CRT) implantation (with or without ICD) between 2016 and 2019 in a single center, all of them followed by remote monitoring. Baseline characteristics and outcomes were compared according to gender. Response to resynchronization was defined as clinical improvement in NYHA class or an increase of &gt; =10% in LVEF. Results A total of 430 devices (ICD or CRT) were implanted. 149 (35%) of them were CRTs: 116 (88%) CRT-D and 33 (22%) CRT-P. Of the whole cohort, 43 (29%) were women and the mean age was similar in both sex (70+/-9 years). Women had more likely non-ischemic cardiomyopathy (86% vs 49%, p &lt; 0.01), higher proportion of NYHA class III-IV (26% vs 40%, p 0.04) and worse renal function (mean glomerular filtration 61ml/min vs 75ml/min, p 0.04), but tend to be less affected by atrial fibrillation (21% vs 40%, p 0.05). Left ventricular ejection fraction was similar at the moment of implantation among both sex (30+/-7%, p &gt; 0.05) and no difference on optimal medical treatment was observed. Women trend to receive more frequently CRT-P than men (33% vs 18%, p 0.054). After a mean follow-up of 3 years, a four-fold higher response to CRT was observed in women (OR 4.0, 95% CI 2.0-10.7, p 0.002), after adjustment by the etiology of the myocardiopathy. No differences on all-cause mortality (6% in men vs 1% in women, p 0.2) or ventricular arrhythmias (10% in men vs 2% in women, p 0.3) were observed.  Conclusions in a real-life cohort, CRT implantation showed a sex-disparity: the proportion of women receiving a CRT was lower than in men, but a CRT without defibrillation was more frequently implanted in women, reflecting a higher prevalence of ischemic cardiomyopathy in men. The underlying myocardial substrate in women and a lower prevalence of AF may explain a more favorable response to CRT, despite more pronounced symptoms of heart failure at the moment of implantation.

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.

Impact of chronic sequential LV-RV pacing with cardiac resynchronization therapy for patients with narrower (<130 ms) QRS complexes following evaluation of acute myocardial strain characteristics

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Kantharia ◽  
A Singh ◽  
R Karnik ◽  
A Shah ◽  
L Wu ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Speckle Tracking ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction ◽  
Writing Group ◽  
Rv Pacing

Abstract Background Prior studies have shown acute improvement in myocardial strain patterns (SP) and strain rates (SR), left ventricular ejection fraction (LVEF), and long-term clinical improvement by Cardiac Resynchronization Therapy (CRT) preferential LV pacing. This relationship has not been studied in patients (pts) with narrower QRS. Objectives We aimed to evaluate myocardial speckle tracking SP and SR at different VV intervals in pts with narrow (&lt;130 ms) and wide (&gt;130 ms) QRS. Methods We assessed LVEF and speckle tracking myocardial SP and SR as per the American Society of Echocardiography (ASE) Dyssynchrony Writing Group methods in pts with CRT in acute settings at VV0, VV60 and LV-only pacing. For SP assessment, we used Bull's eye format display of the LV segments, and scores for SR, 2 = early stretch, late peak, 1= early stretch, early peak, and 0 = single peak at aortic closure. Results Total cohort of 271 pts; age 69.2±10.3 yrs (mean ± SD), male - 60%, divided into 2 groups; Gp A (QRS &lt;130 ms, n=69) and Gp B (QRS &gt;130 ms, n=202). QRS width and LVEF in Gp A and B were 120.1±12.3 ms and 152.1±12.9 ms, and 22.3±9.4% and 23.3±10.2% respectively. With VV0 increase in LVEF, 67±6.0% from baseline 22.3±9.4% was seen in Gp A compared to 43±6.5% from 23.3±10.2% in Gp B (p&lt;0.01). With VV60 and LV-only pacing further rise in LVEF to 100.0±7.1% and 112.0±7.2% in Gp A and 80.2±8.0% and 93±8.1% in Gp B was seen. (Figure 1). Strain scores at different VV timings in both groups are shown in Table 1. Conclusions In pts with CRT, different VV timings show differences in acute myocardial speckle tracking SP and SR, and LVEF. These changes are markedly favorable with LV-only and sequential LV-RV pacing even in pts with narrower QRS. Our findings support chronic sequential LV-RV pacing programming in CRT pts with narrow QRS. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 11478: Excellent Clinical Courses of Autologous Skeletal Myoblast Sheet Transplantation Compared to a Propensity Score-Matched Cardiac Resynchronization Therapy (Best of Basic Science Abstract)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Teruhiko Imamura ◽  
Koichiro Kinugawa ◽  
Yasushi Sakata ◽  
Shigeru Miyagawa ◽  
Yoshiki Sawa ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Control Group ◽  
Resynchronization Therapy ◽  
Skeletal Myoblast

Introduction: We recently reported a multi-center, single-arm, phase II study that evaluated the efficacy and safety of autologous skeletal myoblast sheet (TCD-51073) transplantation. The advantage of this procedure over a control group has not yet been analyzed. Hypothesis: TCD-51073 has better clinical outcome compared with background-matched control group. Methods: Seven patients with advanced heart failure due to ischemic etiology (TCD-51073 group, New York Heart Association [NYHA] class III; left ventricular ejection fraction (LVEF) <35%) refractory to optimal medical and coronary revascularization therapy, received TCD-51073 at 3 study centers between 2012 and 2013 with a 2-year follow-up period. As previously reported, 112 patients received cardiac resynchronization therapy (CRT) with follow-up at the University of Tokyo Hospital between 2007 and 2014. Results: Of them, 21 patients were selected for the control group by propensity score matching. No significant difference in baseline variables between the groups was observed. LVEF and NYHA class improved significantly in the TCD-51073 group during the 6-month study period (p<0.05). During the 2-year follow-up, 7 patients (33%) in the CRT group and no patient in the TCD-51073 group died due to cardiac disease or received VAD implantation (p=0.128 by the log-rank test). Conclusions: Transplantation of TCD-51073 is clinically advantageous in facilitating LV reverse remodeling, improving HF symptoms, and preventing cardiac death in patients with ischemic etiology when compared to background-matched patients receiving CRT.

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