Abstract 4349: Usefulness of Echocardiographic Measures of Dyssynchrony in Patients with Borderline QRS Duration for Selection for Resynchronization Therapy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Olusegun Oyenuga ◽  
Hideyuki Hara ◽  
Hidekazu Tanaka ◽  
Han-Na Kim ◽  
Samir Saba ◽  
...  
Keyword(s):  
Radial Strain ◽  
Tissue Doppler ◽  
Cardiac Resynchronization ◽  
Class Iii ◽  
Resynchronization Therapy ◽  
Filling Time ◽  
Qrs Duration ◽  
Selection For ◽  
Selection Of Patients ◽  
Selection Of

Although echo dyssynchrony has not replaced routine selection criteria for cardiac resynchronization therapy (CRT) in patients with wide QRS, our objective was to test the hypothesis that dyssynchrony may assist in selection of patients for CRT with borderline QRS duration. We studied 119 heart failure patients referred for CRT; all were Class III-IV with ejection fraction (EF) ≤35%: 79 had Wide-QRS ≥130ms (169 ±28ms), and 40 had Borderline-QRS 100 –130ms (116 ±7ms). Dyssynchrony was assessed using tissue Doppler (TDI) longitudinal velocities from apical views (≥65ms opposing wall delay) and speckle tracking radial strain (≥130 ms septal to post. wall delay). Pulsed Doppler assessed interventricular mechanical delay (IVMD) (≥40ms), and filling time/RR interval (FT/RR ≤40%). Patients were followed for 8±5 months. Response to CRT was defined as ≥15% increase in EF. Overall, 77% of the Wide-QRS group were EF responders in contrast to 65% of the Borderline-QRS group. TDI was 87% sensitive and 67% specific for predicting response in the Wide-QRS group, but only 46% specific in the Borderline-QRS group. Radial dyssynchrony was the best predictor of response in the Borderline-QRS group with 80% sensitivity and 92% specificity. Although IVMD and FT/RR had low sensitivities, they were 100% specific. EF response to CRT is less frequent in patients with Borderline-QRS than in those with Wide-QRS. Radial dyssynchrony appears to be the best predictor of EF response in Borderline-QRS patients; IVMD and FT/RR were highly specific. A combined echo assessment of dyssynchrony has potential to assist in selection of patients for CRT with borderline QRS.

Abstract 3778: Racial and Ethnic Differences in Cardiac Resynchronization Therapy Outside of Published Guidelines

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Steven A Farmer ◽  
James N Kirkpatrick ◽  
Paul A Heidenreich ◽  
Jeptha P Curtis ◽  
Yongfei Wang ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Ethnic Differences ◽  
Coronary Revascularization ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Class Iii ◽  
Resynchronization Therapy ◽  
Racial And Ethnic Differences ◽  
Qrs Duration ◽  
White Patients

Objective Ethnic and racial disparities in cardiac care may partially result from over-provision of care among white patients. We hypothesized that whites were more likely than blacks and Hispanics to receive cardiac resynchronization therapy with defibrillator (CRT-D) devices outside of ACC/AHA/HRS guidelines. Methods We analyzed 01/2005– 04/2007 data from the ACC-National Cardiovascular Data Registry for implantable cardioverter-defibrillators (ICDs). We identified white, black and Hispanic patients who received CRT-D. We then fit a multivariable hierarchical logistic regression model with full ACC/AHA/HRS guideline concordance (QRS duration >=0.12 ms, LVEF <<26>35%, and class III or IV CHF) as a binary outcome. Independent variables included race/ethnicity, age, gender, cardiomyopathy etiology, duration of CHF, LVEF, blood pressure, QRS duration/morphology, prior coronary revascularization, atrial fibrillation, cerebrovascular disease, hypertension, diabetes, renal failure, and pulmonary disease. Results Of 108,341 registry patients, 39,088 CRT-D recipients were selected, including 33,310 (85%) non-Hispanic whites, 3,963 (10%) non-Hispanic blacks, and 1,815 (5%) Hispanics. Among all CRT-D recipients, univariate analyses indicated 9,430 (24%) patients lacked 1 CRT-D criterion, 1,840 (5%) patients lacked 2 criteria, and 217 (1%) patients lacked all 3 criteria. Specifically, 2,271 (6%) had an LVEF >35%, 6,758 (17%) had class I/II CHF, and 4,732 (12%) had a QRS duration <0.12 ms. In multivariate analyses, blacks (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.04 –1.23; p=0.004) and Hispanics (OR 1.10, 95% CI 0.97–1.24; p=0.13) were more likely to meet all 3 CRT-D eligibility criteria than non-Hispanic whites. Conclusions After multivariate adjustment, we observed greater guideline-concordant use of CRT-D among blacks and Hispanics than among non-Hispanic whites. Although it is possible that patients receiving CRT-D outside of published guidelines had other compelling clinical findings unrecorded in the registry, such as echocardiographic evidence of dyssynchrony, our findings suggest that racial and ethnic differences in CRT-D partially may be due to over-provision of this technology among white patients.

Abstract 3286: Prediction for Long-term Effect Of Cardiac Resynchronization Therapy: Comparison Between Tissue Doppler Imaging And Speckle Tracking Imaging

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Azusa Furugen ◽  
Naoki Matsuda ◽  
Kyomi Ashihara ◽  
Asako Mochida ◽  
Morio Shoda ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Tissue Doppler Imaging ◽  
Speckle Tracking ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Speckle Tracking Imaging ◽  
Resynchronization Therapy ◽  
Time To Peak ◽  
Qrs Duration

Recent studies have demonstrated that the septal-to-posterior motion delay (SPWMD) assessed by M-mode echo and the longitudinal intra-LV dyssynchrony assessed by tissue Doppler imaging (TDI) can predict chronic effects of cardiac resynchronization therapy (CRT). A newly developed 2D speckle tracking imaging (STI) has enabled assessment of not only longitudinal but circumferential regional strain of LV. We investigated the usefulness of STI in selecting patients for CRT. Methods: Fifty-one patients with heart failure symptoms and QRS duration>120 ms underwent standard echocardiography, TDI and STI before CRT. Time to peak systolic velocity was measured in 12 basal and mid LV segments in apical views by TDI. The time difference between the basal septal and the basal lateral segments was calculated (TDI-SLPVD).The standard deviation of those among 12 segments was calculated (TDI-SD). Time to peak circumferential strain, radial strain and longitudinal strain were measured in basal segments in parasternal short axis and apical views by STI. The time difference between the septal and the lateral segments was calculated (CS-SL, RS-SL and LS-SL). A responder to CRT was defined as a patient whose NYHA class improved by >1 class and whose LVESV reduced by >10% at 6 months after CRT. Results: Thirty-six patients (71%) responded to CRT. CS-SL showed high sensitivity and specificity for predicting the responders at a cut-off point of 124 ms (Table ). The area under the ROC curve (AUC) of CS-SL was larger than that of QRS duration, SPWMD, TDI-SLPVD, TDI-SD, RS-SL and LS-SL. Conclusion: Assessment of circumferential dyssynchrony using STI seems useful in selecting patients for CRT.

scholarly journals Strategies to Improve Selection of Patients Without Typical Left Bundle Branch Block for Cardiac Resynchronization Therapy

2020 ◽  
Vol 6 (2) ◽  
pp. 129-142 ◽  
Author(s):  
Odette A.E. Salden ◽  
Kevin Vernooy ◽  
Antonius M.W. van Stipdonk ◽  
Maarten J. Cramer ◽  
Frits W. Prinzen ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Bundle Branch Block ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Selection Of Patients ◽  
Selection Of

Use of Technetium-99m-Labeled Methoxy-Isobutyl Isonitrile and Iodine 123-Labeled Phenyl-Methyl-Pentadecanoic Acid in the Diagnosis and Prognosis of Patients with Dilated Cardiomyopathy

2015 ◽  
Vol 1084 ◽  
pp. 532-535
Author(s):  
Yuri B. Lishmanov ◽  
Konstantin V. Zavadovsky ◽  
Marina O. Gulya ◽  
Stanislav M. Minin ◽  
Denis I. Lebedev
Keyword(s):  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Pentadecanoic Acid ◽  
Resynchronization Therapy ◽  
Diagnosis And Prognosis ◽  
Metabolic Defects ◽  
Iodine 123 ◽  
Selection Of Patients ◽  
Selection Of

The objectiveof this study is to assess perfusion and metabolic state of the left ventricular in patients with dilated cardiomyopathy (DCM) using scintigraphy with MIBI and BMIPP, as well as to develop the predictors of efficacy of cardiac resynchronization therapy (CRT). The study included 51 patients with DCM who underwent CRT. Correlation between the values of LV ESV after CRT and preoperative perfusion and metabolic defects sizes was detected. "Responders" and "non-responders" groups were significantly different from the perfusion and metabolic defects sizes. Myocardial perfusion-metabolic scintigraphy can be used as additional criteria for the selection of patients for CRT.

scholarly journals New echocardiographic techniques in optimal patient selection for cardiac resynchronization therapy in the treatment of chronic heart failure

2009 ◽  
Vol 137 (5-6) ◽  
pp. 304-309
Author(s):  
Milan Petrovic ◽  
Bosiljka Vujisic-Tesic ◽  
Goran Milasinovic ◽  
Danijela Zamaklar-Trifunovic ◽  
Ivana Nedeljkovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Cardiac Resynchronization Therapy ◽  
Patient Selection ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Selection For ◽  
Consensus Report

Cardiac resynchronization therapy (CRT) has important role in the contemporary treatment of heart failure, systolic dysfunction and mechanical disynchrony. Classical indications for CRT are severe heart failure (NYHA class III or IV), a broad QRS (more than 120 ms) and left ejection fraction less than 35% despite optimal medical therapy. Several have studies demonstrated the important role of echocardiography in patient selection for CRT, follow up and estimation of CRT effects, as well as the optimization of biventricular pacemaker. Basically, there are three types of cardiac asynchrony: interventricular asynchrony, between the right and left ventricle, intraventricular asynchrony, between the myocardial segments within the left ventricle and atrioventricular asynchrony, between the atria and ventricles. Although many echocardiographic techniques are used in patient selection for CRT, no ideal approach has yet been found. There are several techniques and parameters used in the assessment of myocardial asynchrony: two dimensional (2D) echocardiography, one dimensional echocardiography (M-mode), Doppler echocardiography, different modalities of tissue Doppler including Colour Coded Tissue Doppler Imaging - TDI, measurements of local tissue deformation indices (strain and strain rate), speckle tracking, 3D echocardiography, semiquantitative assessment of myocardial border, vector velocity imaging. Each of these techniques has advantages and limitations. A special accent in this revue is on the consensus report from the American Society of Echocardiography Dyssynchrony Writing group. According to this consensus report color coded tissue Doppler is the most appropriate technique for myocardial asynchrony estimation and patients selection for CRT. The same group recommended that definitive decision for CFT implantation should not be based only on echocardiographic analysis, but rather on the whole clinical aspect of the patient.

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